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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References
- Acute airway management: Role of cricothyroidotomy.Am Surg. 1990; 56: 12-15
- Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome.Ann Emerg Med. 1990; 3: 279-285
- Emergency cricothyroidotomy in trauma victims.J Trauma. 1993; 34: 503-505
- Cricothyroidotomy: A decade of experience in Denver.Ann Otol Rhinol Laryngol. 1987; 96: 519-524
- Cricothyrotomy in the emergency department revisited.J Emerg Med. 1989; 7: 115-118
- Emergency cricothyrotomy: A reassessment.Am Surg. 1995; 61: 52-55
- Cricothyrotomy in the emergency department.Ann Emerg Med. 1982; 11: 361-364
- Surgical cricothyrotomy performed by air ambulance flight nurses: A 5-year experience.J Emerg Med. 1993; 11: 41-45
- Difficult intubations: Aids and alternatives.Am Family Physician. 1985; 31: 99-112
- Retrograde intubation of the pharynx: An unusual complication of emergency cricothyrotomy.Ann Emerg Med. 1992; 21: 220-222
- Management of the difficult adult airway.Anesthesiology. 1991; 75: 1087-1110
- Cricothyrotomy performed by prehospital personnel: A comparison of two techniques in a human cadaver model.Am J Emerg Med. 1993; 11: 207-209
- Cricothyrotomy in air medical transport.J Trauma. 2008; 64: 1543-1547
- Cricothyrotomy: A 5-year experience at one institution.J Emerg Med. 2003; 24: 151-156
- Retrograde intubation of the pharynx: An unusual complication of emergency cricothyrotomy.Ann Emerg Med. 1992; 21: 220-222
- Cricothyroidotomy.Emerg Med Clin North Am. 1988; 6: 725-736
- Emergency cricothyrostomy: Technique and anatomical considerations.J Emerg Med. 1985; 2: 443-446
- The dimensions and vascular anatomy of the cricothyroid membrane: relevance to emergent surgical airway access.Clin Anat. 1996; 19: 291-295
- An easy cricothyrotomy approach: The rapid four-step technique.Acad Emerg Med. 1996; 3: 1060-1063
- Safety and efficacy of the Rapid Four-Step Technique for cricothyrotomy using a Bair Claw.J Emerg Med. 2000; 19: 125-129
- Comparison of 2 cricothyrotomy techniques: Standard method versus rapid 4-step technique.Ann Emerg Med. 1998; 32: 442-446
- A comparison of a novel cricothyrotomy device with standard surgical technique.Acad Emerg Med. 1997; 4 ([abstract].): 488
- Cricothyrotomy technique: Standard versus the rapid four-step technique.J Emerg Med. 1999; 17: 17-21
- Cricothyrotomy concerns.Acad Emerg Med. 1997; 4 ([letter].): 1006-1007
- Three-step emergency cricothryoidotomy.Mil Med. 2007; 172: 1228-1230
- Use of a gum elastic bougie during surgical crichothyrotomy.Am J Emerg Med. 2008; 26: 738.e1
- Difficult Airway Society equipment list: Recommended equipment for management of unanticipated difficult intubation.(Accessed July 2005.)
- The airway*cam guide to intubation and practical emergency airway management. AirwayCam Technologies, Inc., Wayne, PA2004
- A flexible solution for emergency intubation difficulties.Ann Emerg Med. 1996; 27: 665-667
- Use of gum elastic bougie for prehospital difficult intubation.Am J Emerg Med. 2005; 23: 552-555
- Use of the gum elastic bougie as an adjunct for orotracheal intubation in the emergency department [Abstract].Acad Emerg Med. 2000; 7: 526
- Successful difficult intubation: Tracheal tube placement over a gum-elastic bougie.Anaesthesia. 1990; 45: 774-776
- Simulated difficult intubation: comparison of the gum elastic bougie and the stylet.Anaesthesia. 1996; 51: 935-938
- A comparison of a fiberoptic stylet and a bougie as adjuncts to direct laryngoscopy in a manikin-simulated difficult airway.Ann Emerg Med. 2007; 50: 676-685
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