According to Japanese guidelines, the cricothyroid ligament incision is a transverse incision. But there are cases when the neck swelling is so severe that even the thyroid cartilage cannot be located, in which case a transverse incision would be easily misplaced.
Surprisingly to some, many patients can be maintained with nothing more than an oral airway and bag. Others require endotracheal intubation. Personally, I have never failed to intubate successfully and atraumatically. This is the result of having done very large numbers as an intern and resident. The only times I have had to do surgical intubations with the technique shown here or with formal tracheostomy were when others had started the procedure and were encountering difficulties requiring assistance. Moral: Learn to intubate correctly even under difficult conditions.
Well said! I could not agree more. I will say there maybe one time were an emergent cric would be necessary, which is the one time I’ve done this. And it was in a patient with severe tongue swelling/angioedema. In this case events happened so rapidly, we tried video, we tried fiber optic, but airway was too swollen and patient became very agitated. We then quickly decided to do the cric. The patient did great and walked about of the hospital a few weeks later!
Of the 2 that I can recall, one was similar to yours and the other was a retropharyngeal abscess pt. in resp. distress for whom I had the extra couple of minutes to do a tracheostomy. Both enjoyed good outcomes.
If you haven't had a problem doing a routine procedure, you haven't done enough of them. It has nothing to do with skill or technique, it’s all about odds and probability. The key is to know what to do when something totally unexpected happens when you least expect it.
Emergency Cric's save many lives on the battlefield. They are fast and we don't have to waste time intubating to get the same if not better result. In a controlled setting like a comfy hospital it would seem to think this is a very last resort procedure but It's great on a bloody messy battlefield where the person is most likely going to suffer heavy facial trauma.
ever run across a situation like mine? refer to my description of botched cesarean delivery - prior to being wheeled back into or - ob had given me 10 bag of platelets, 9 bags of whole blood and 11 bags of (shoot, can't remember, lol - 23 years ago) - but I was so swollen by the time I got back to the or, they couldn't intubate - doctor told me I had 30 seconds to live - he saved my life.
please tell me , is it possible to do it in the side of the neck ? this is what that did to me, I wake up with normal tracheotomy from the mouth , but I had cut in the side neck catheter closed ( larger and different from normal catheter for injection ), 2 visible stitch and 2 other catheters where nurse ones did an injection , I asked after couple of days when I could speak ( and remove tracheotomy ) she side sometimes doctors in emergency situation choose to do tracheotomy in the side and sometime in the middle of the neck , I was in hospital for 11 days, and now I'm out since more then 15 days but still hurt in the side neck where they cut, I tried to find in internet how and is it possible to do tracheotomy in the side neck but I didn't find anything about that, is it possible ? i'm perplexe , I'm happy that they did it in the side so I'll not have visible scar if they perform it in the middle, can someone tell me ? thanks:). ps. they told me they perform it not in emergency room but in the hallway of the hospital far from emergency section where I loose conscious and couldn't breath.
when there is a need for an immediate surgical airway when someone can't intubate, there is no time to play around... Emergency staff is better off doing the easy procedure such a CRICthyroidotomy as a temporary airway to keep the patient alive ...however, if an ent surgeon is there he can do a tracheostomy immediately which is way more technical.
Salvaria muitas vidas perdidas por mortes evitáveis, se os plantonistas de sala de emergência fossem de fato comprometidos em aprender os protocolos que deveriam saber.
Nice demonstration however my seniors have taught me that a vertical skin incision is not a part of cricothyroidotomy it should be one horizontal incision down to the cricothyroid membrane if anyone has any suggestions regarding this?
how do you do this properly with just a pen? i know there was a study where only 1 out of 10 people could push a pen through a 2 day old human cadaver's throat, and it took the person 5 minutes, so chances are slim. but it still may be a life saved, especially if done properly. so how is that done properly? (assuming you have only a pen, no knife or any other sharp object around)
@Aaron Turner Hi. Why though? The alternative is dying. If you do it (the emergency crico-thing with a pen), you may end up dying, but if you don't do it, you will for sure die. So you're actually not risking anything.
This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.
I had one done in 1996 - after severe blood loss after botched cesarean section (baby was ok) - I wasn't though - when you lose 2/3 of your blood volume, your bp is 28/19 - and you have ARDS and DIC plus complete white out of the lungs - then you better hope there is an experienced trauma surgeon around - one that can save your life.
They could, if they are properly trained in this procedure and they have the right materials in a clinical setting. It's important to know that outside of hospital settings, in first aid, laws like good samaritian laws apply. What they cover differs through countries and states. Meaning that such a highly invasive procedure without the right training and material, might be leaving one open to lawsuits.👍🏻
This should be done only by a doctor because a person not familiar with anatomy can damage major vessels or nerves or even puncture trachea. Don't try it at home under any situation
@@akanksha2273 OMFG Are you serious? Wchich part of "is performed to obtain an airway when you cannot obtain another means of a definitive airway." didn't you understand excacly? "Don't try it at home under any situation" - sure, let the man die, it's better than puncturing trachea.
@@brunonkowalski are you a medical professional? I don't think so. Because if you were you would know how to obtain an airway at home. Do you even know where your carotid is located and how important it is,or your vagus nerve or your thyroid???do you even know how to intubate? So i am sorry that no one wants to teach you how to stab a man in his throat. If any such situation arises you are free to call 911 or any health facility and then ask them for directions. You may just kill the person or damage the vocal cords of a person who may just need to be intubated.
@@akanksha2273 Do you know how important oxygen is? I will explain to you. Human being cannot live more than a few minutes without it, so if someone choked with something and can't breathe and back blows and chest thrusts don't work feel free to let the man die.
@@brunonkowalski dude no one starts to do cricothyroidotomy in a patient straightaway. Your job ends by calling 911and repeating thrust and blows for that patient. If that patient becomes unconscious then you are authorised to administer cpr. Unlike your medical drama no one jumps to slit a patient's throat open. Do you even know the basic anatomy of neck? Blood vessels that run in your neck? Or even cpr? 90% of the patients are managed with endotracheal tube and dont need to get this procedure done. God forbid where you have to perform the procedure..take a pen containing a refill and insert it across cricothyroid membrane. After that remove the refill. A temporary airway will be established which will be good for 10-15 minutes. This is a very risky procedure and you can do more harm than good. So first always call 911 and perform cpr.
This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario.
I did one today for the first time ever as a medic in the field very insane experience
Your a hero Khallid
No body cares man
@@ayushkandoi2477 I care
Well done
what was the indication?
Bro this is the exact education we need. You taught us basically everything we are likely to get confused with
Kick ass, best Cric demo I've seen on youtube.
Excelent explanation to expert doctors 👍🏽👍🏽 thanks a lot.
The information is really great, the explanations are clear and the presentations are elegant! Great example of FOAMed!
you guys are seriously a hidden gem, loving all your videos so far!!
Scary but necessary. Respect to all the docs and parameds
According to Japanese guidelines, the cricothyroid ligament incision is a transverse incision. But there are cases when the neck swelling is so severe that even the thyroid cartilage cannot be located, in which case a transverse incision would be easily misplaced.
Therefore, I personally feel that if the neck swelling is severe and dangerous, a vertical incision like the one in this video would be better.
You are literally the best youtube channel 👐 huge respect for your effort💎
Amazing....glad found this channel. Subscribed immediately
Excellent demonstration.thak you 👍🏻👍🏻
this chanel is amazing! Keep with your good work
Eduardo! thanks for the kind words!
Excellent video, glad I found it.
Good explanation
Surprisingly to some, many patients can be maintained with nothing more than an oral airway and bag. Others require endotracheal intubation. Personally, I have never failed to intubate successfully and atraumatically. This is the result of having done very large numbers as an intern and resident. The only times I have had to do surgical intubations with the technique shown here or with formal tracheostomy were when others had started the procedure and were encountering difficulties requiring assistance. Moral: Learn to intubate correctly even under difficult conditions.
Well said! I could not agree more. I will say there maybe one time were an emergent cric would be necessary, which is the one time I’ve done this. And it was in a patient with severe tongue swelling/angioedema. In this case events happened so rapidly, we tried video, we tried fiber optic, but airway was too swollen and patient became very agitated. We then quickly decided to do the cric. The patient did great and walked about of the hospital a few weeks later!
Of the 2 that I can recall, one was similar to yours and the other was a retropharyngeal abscess pt. in resp. distress for whom I had the extra couple of minutes to do a tracheostomy. Both enjoyed good outcomes.
If you haven't had a problem doing a routine procedure, you haven't done enough of them. It has nothing to do with skill or technique, it’s all about odds and probability. The key is to know what to do when something totally unexpected happens when you least expect it.
Emergency Cric's save many lives on the battlefield. They are fast and we don't have to waste time intubating to get the same if not better result. In a controlled setting like a comfy hospital it would seem to think this is a very last resort procedure but It's great on a bloody messy battlefield where the person is most likely going to suffer heavy facial trauma.
ever run across a situation like mine? refer to my description of botched cesarean delivery - prior to being wheeled back into or - ob had given me 10 bag of platelets, 9 bags of whole blood and 11 bags of (shoot, can't remember, lol - 23 years ago) - but I was so swollen by the time I got back to the or, they couldn't intubate - doctor told me I had 30 seconds to live - he saved my life.
thanks, you are the best!
realy usefull video, keep up with your good work 👌👍
thank you so much for this vid!
Thanks❤
thank you
Nice video 👍
Thanks for the explanation
Excellent video.
Awesome work guys 👌❤️
Wow!! Amazing. Thanks for sharing.
I would like to use this for a lecture, appropriately credited
Great video. New follower.
please tell me , is it possible to do it in the side of the neck ? this is what that did to me, I wake up with normal tracheotomy from the mouth , but I had cut in the side neck catheter closed ( larger and different from normal catheter for injection ), 2 visible stitch and 2 other catheters where nurse ones did an injection , I asked after couple of days when I could speak ( and remove tracheotomy ) she side sometimes doctors in emergency situation choose to do tracheotomy in the side and sometime in the middle of the neck , I was in hospital for 11 days, and now I'm out since more then 15 days but still hurt in the side neck where they cut, I tried to find in internet how and is it possible to do tracheotomy in the side neck but I didn't find anything about that, is it possible ? i'm perplexe , I'm happy that they did it in the side so I'll not have visible scar if they perform it in the middle, can someone tell me ? thanks:). ps. they told me they perform it not in emergency room but in the hallway of the hospital far from emergency section where I loose conscious and couldn't breath.
Thank You!!
Thank you!
Excellent vid!
Amazing
How do you decide when to do cricothyrodotomy vs tracheostomy?
when there is a need for an immediate surgical airway when someone can't intubate, there is no time to play around... Emergency staff is better off doing the easy procedure such a CRICthyroidotomy as a temporary airway to keep the patient alive ...however, if an ent surgeon is there he can do a tracheostomy immediately which is way more technical.
@@sharadmohip6536no, surgical tracheostomy won't be as fast as required in an emergency.
Awesome video. Keep them coming!
Wow cool!
Life is so presious
Excellent explanation. Thanks!
awesome
Salvaria muitas vidas perdidas por mortes evitáveis, se os plantonistas de sala de emergência fossem de fato comprometidos em aprender os protocolos que deveriam saber.
Nice demonstration however my seniors have taught me that a vertical skin incision is not a part of cricothyroidotomy it should be one horizontal incision down to the cricothyroid membrane if anyone has any suggestions regarding this?
The vertical incision for cric, horizontal for trach.
Vertical skin incision is for emergency procedure as it is with rapid access and minimal bleeding and tissue dissection
will a pen do the trick in an emergency, if that person can't breathe
So wait , what is the difference in this and a tracheostomy?
Nice
🙏🙏🙏
how do you do this properly with just a pen? i know there was a study where only 1 out of 10 people could push a pen through a 2 day old human cadaver's throat, and it took the person 5 minutes, so chances are slim. but it still may be a life saved, especially if done properly. so how is that done properly? (assuming you have only a pen, no knife or any other sharp object around)
@Aaron Turner Hi. Why though? The alternative is dying. If you do it (the emergency crico-thing with a pen), you may end up dying, but if you don't do it, you will for sure die. So you're actually not risking anything.
This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.
great video ... but who walks in the middle of the road
All of the videos I can find on this are on men
wow
Yep the guy with his head tilted back has a sweet adams apple nice and big.
I had one done in 1996 - after severe blood loss after botched cesarean section (baby was ok) - I wasn't though - when you lose 2/3 of your blood volume, your bp is 28/19 - and you have ARDS and DIC plus complete white out of the lungs - then you better hope there is an experienced trauma surgeon around - one that can save your life.
btw botched = severing uterine artery and not repairing it
My neck feels weird 😩
please EQ your audio
his cords are swollen shut...... effffff
If there’s no Doc to do this, can a Nurse jump in?
They could, if they are properly trained in this procedure and they have the right materials in a clinical setting. It's important to know that outside of hospital settings, in first aid, laws like good samaritian laws apply. What they cover differs through countries and states. Meaning that such a highly invasive procedure without the right training and material, might be leaving one open to lawsuits.👍🏻
1:03 it's Trump!
That's you're take away from this video?
2 : 25
Show instructions how to do it at home without any special medical tools.
This should be done only by a doctor because a person not familiar with anatomy can damage major vessels or nerves or even puncture trachea. Don't try it at home under any situation
@@akanksha2273 OMFG Are you serious? Wchich part of "is performed to obtain an airway when you cannot obtain another means of a definitive airway." didn't you understand excacly?
"Don't try it at home under any situation" - sure, let the man die, it's better than puncturing trachea.
@@brunonkowalski are you a medical professional? I don't think so. Because if you were you would know how to obtain an airway at home. Do you even know where your carotid is located and how important it is,or your vagus nerve or your thyroid???do you even know how to intubate? So i am sorry that no one wants to teach you how to stab a man in his throat. If any such situation arises you are free to call 911 or any health facility and then ask them for directions. You may just kill the person or damage the vocal cords of a person who may just need to be intubated.
@@akanksha2273 Do you know how important oxygen is? I will explain to you. Human being cannot live more than a few minutes without it, so if someone choked with something and can't breathe and back blows and chest thrusts don't work feel free to let the man die.
@@brunonkowalski dude no one starts to do cricothyroidotomy in a patient straightaway. Your job ends by calling 911and repeating thrust and blows for that patient. If that patient becomes unconscious then you are authorised to administer cpr. Unlike your medical drama no one jumps to slit a patient's throat open. Do you even know the basic anatomy of neck? Blood vessels that run in your neck? Or even cpr? 90% of the patients are managed with endotracheal tube and dont need to get this procedure done. God forbid where you have to perform the procedure..take a pen containing a refill and insert it across cricothyroid membrane. After that remove the refill. A temporary airway will be established which will be good for 10-15 minutes. This is a very risky procedure and you can do more harm than good. So first always call 911 and perform cpr.
This is why they pay so much in every way.
Again you looking at the most ideal scenario: 1- doc knows anatomy 2-he can locate Cricothyroid membrane....those are only the best scenarios...
The difficult anatomy looked like trump.
loool Sure. People are normally, carrying these tools with them.
This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario.
Ok, half of the video is black screen... no effort putting there...
Lovely
❤️❤️
Thank you!!