Surgical cricothyroidotomy is considered a critical skill in emergency airway management,
though it is rarely used and fraught with complications. A variety of approaches are
taught, including both the standard and rapid four-step techniques. We report a case
in which an air medical crew used a gum-elastic bougie (endotracheal tube introducer),
a common device in many airway kits, to facilitate surgical cricothyroidotomy in a
58-year-old patient with a pharyngeal mass, respiratory failure, and failed rapid
sequence induction. We believe this technique may decrease the time until ventilation,
minimize complications compared with other cricothyroidotomy techniques, and allow
insertion of a larger-diameter endotracheal tube compared with other techniques.
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