Posted by Matthew Mac Partlin on Saturday, May 19, 2012

Airway management is a hot topic amongst ED, critical care and pre-hospital communities and emergency cricothyroidotomies are generally the procedures that create the most angst. Largely it's the decision that it needs to be performed that fills most pants, rather than the actual doing. But just to make it a bit more troublesome, there are several approaches that are promoted.

Two Adelaide anaesthetists who also work in retreival, have reported their combined experience of establishing 24 surgical airways and a description of the "scalpel-finger-tube" approach to the emergency surgical cric that's worth a read.

The technique is fast. It uses only 3 items of equipment (4 if you count your little finger). And they argue that you can be confident of the final tube placement (I'm a little less convinced of this bit as it seems to me that there is reasonable potential for the creation of a false passage as the scalpel is replaced by a finger, which is then removed so the ETT can be placed, and all through soft, freshly incised tissue. However, I haven't performed 24 surgical airways.)

It's a handy technique to know about, especially in a pre-hospital situation like many motorsports events, where weight and volume come at a premium when packing kit.