The Dreaded Cricothyrotomy

​I'll admit it. I hate the cricothyrotomy. It's not because I haven't done one for a decade or because it is a complicated procedure. Or because I dread the thought of leaving a permanent cosmetic defect on someone's neck. Or because it is a procedure performed as a last resort under extreme time pressure on a hypoxic patient who will almost assuredly die if you fail.It has something to do with the word failed, as in failed airway. That surgical airway is there because the physician could not gain effective control of the patient's airway using all of the other airway tools at his disposal. We all understand that failure is part of the reason we have to perform a surgical airway. And we know that all of our colleagues will be Monday morning quarterbacks debating whether a surgical airway was necessary.I remember during a residency rotation in the SICU listening to derisive comments about the emergency department when an admission arrived with a cricothyrotomy. My worst nightmare played out. Someone even referred to the bloody bandage on the patient's neck as the "red badge of shame."There are, however, actual occasions where it remains necessary and appropriate to perform a cricothyroidotomy because of facial trauma or extreme swelling. Depending on the type of hospital, it occurs about one percent of the time, lower now most likely due to the availability of video laryngoscopes and increased sophistication of alternative airway options.We can break the cricothyro...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs