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cric's
Just to echo doc-T (a fellow trauma surgeon) the cric is usually a last ditch effort...most patients can be managed with BVM and a nasal airway.....that said, if the cric is going to happen don't fall into the trap of abandoning the procedure due to bleeding. I do and teach the vertical incision also....the anterior jugular veins are 1) always present, 2) always distended unless the patient lost a lot of blood and 3) have a 30-40% incidence of being in the wrong place. All that you'll cut with the vertical incision is the bridging anterior jugular and that typically is small and the cric apparatus usually compresses it. That being said the #1 reason people abandon the cric once initiated is BLEEDING. Remember that A comes before B or C.....I know, I'm preaching to the choir on this one but if you start it, finish it...isn't that one of your motto's anyway? (I hope that wasn't in bad taste!!!)
I have a saying....no one dies without an airway...believe it, live it.
T-2
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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