The Cutting Edge of Adult Cricothyrotomy: Are EMS Protocols Keeping Up?

An ALS unit is dispatched for an adult patient complaining of severe painful swallowing and difficulty breathing. Upon arrival the patient is acutely decompensating with increasing respiratory effort and diminished color. Supplemental oxygen isn’t providing adequate perfusion. Due to the patient’s rapidly deteriorating condition, the decision is made to intubate. As the laryngoscope is slid beyond the oral cavity, severe epiglottic swelling is visualized. After one intubation attempt the swelling worsens. At this point, endotracheal intubation is not feasible. With no options left, the paramedic resorts to reaching for the cricothyrotomy kit. Sweat beads on the paramedic’s brow as he questions his ability to perform the procedure. He’s seen very few performed and has never actually done one himself, but this is the only option. With trepidation, the cricothyrotomy kit is opened and the paramedic finds two choices: needle or surgical. He’s unsure what method to choose. Without further evidence to base the decision off of, the paramedic selects the needle technique as it appears less invasive. Was this the right decision? Evidence Basis In “cannot intubate, cannot ventilate” scenarios, prehospital providers are left with few options. The most current algorithms published by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway (United States) and the Difficult Airway Society (United Kingdom) indicate cricothyrotomy as a final e...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Source Type: news