Doc T

few comments...

Nasotracheal intubations are quick and do not require hemodynamic stability...the only requirement in a breathing patient. That said, it is not the first choice of airway due to the risk of sinusitis and risk of necrosis if left for a prolonged period.

As for surgical crics...well, any EMS system that allows RSI needs to teach their prehospital people to perform crics... We have had a few performed in our system that went well, but it is not always that way. It is not a procedure that is performed often in any ER and takes practice to be fast like anything else.

I typically make a longitudinal incision, not transverse as there are anterior jugular veins that tend to get cut in a transverse incision and bleeding just makes the airway more difficult. It usually takes more than two passes of the scapel as the people winding up with surgical airways rarely have long skinny necks. Four or five passes is more typical. And I have never seen anyone use a needle cric except in a child...it is a terrible airway.

doc t.