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swatsurgeon · 06-11-2010, 19:04

farcefiasco,
I have been giving your question more thought and based on my personal experience of digging others out of failed cric's, I will offer the following.
Simulation , once or a hundred times gives you the moves. If you take the cric procedure and divide it up into it's individual components, you are facing challanges that simulation will not provide......
There are a few things to work out in advance that you can work on though....just follow me for a minute.
- exactly what equipment will you be using, nearly every time
- is this a needle cric or a formal with a tube of some kind
- how many times have you reviewed an anatomy book of the neck
- 'if' you access to an ultrasound (u/s) machine: have someone show you what a cricothyroid membrane looks like under u/s guidance, then feel the persons neck...do this on several different people. Now feel their necks and mark the location of the cricothyroid membrane and VERIFY with the u/s.
- how well do you deal with active bleeding from a neck wound? The number 1 reason cric's fail is wrong location, people are fooled by the lower indent of the throid cartilage, second reason they fail is vigorous bleeding and the thought of "oh sh*t" what did I hit!. The neck has anterior jugular veins and in ~15% of people, a bridging jugular that if you make the vertical incision, you will transect and it will bleed magnificently........don't stop, this is where I get called by E.D. docs, residents, PA's, etc.
The manual skills required are few and you can walk through them on a piece of ventilator tubing covered in duoderm or chicken skin.
My point is simulation prepares you ONLY for the steps, nothing else. Will you be doing this in the field, under fire, exhasted, out of breath, with your heart rate faster than the patients...you get my drift. Practice on anything you want so the steps of performing it are hardwired into your brain. Then do the human anatomy lesson. Until you do this on enough humans, you can't get "comfortable" with any procedure.
Best of luck. Thought I'd give you one of my surgical/trauma quotes: "No one dies without an airway"

ss

06-11-2010, 19:04	#5
swatsurgeon Guerrilla Chief Join Date: Jul 2004 Location: Phoenix, AZ Posts: 880	farcefiasco, I have been giving your question more thought and based on my personal experience of digging others out of failed cric's, I will offer the following. Simulation , once or a hundred times gives you the moves. If you take the cric procedure and divide it up into it's individual components, you are facing challanges that simulation will not provide...... There are a few things to work out in advance that you can work on though....just follow me for a minute. - exactly what equipment will you be using, nearly every time - is this a needle cric or a formal with a tube of some kind - how many times have you reviewed an anatomy book of the neck - 'if' you access to an ultrasound (u/s) machine: have someone show you what a cricothyroid membrane looks like under u/s guidance, then feel the persons neck...do this on several different people. Now feel their necks and mark the location of the cricothyroid membrane and VERIFY with the u/s. - how well do you deal with active bleeding from a neck wound? The number 1 reason cric's fail is wrong location, people are fooled by the lower indent of the throid cartilage, second reason they fail is vigorous bleeding and the thought of "oh sht" what did I hit!. The neck has anterior jugular veins and in ~15% of people, a bridging jugular that if you make the vertical incision, you will transect and it will bleed magnificently........don't stop, this is where I get called by E.D. docs, residents, PA's, etc. The manual skills required are few and you can walk through them on a piece of ventilator tubing covered in duoderm or chicken skin. My point is simulation prepares you ONLY for the steps, nothing else. Will you be doing this in the field, under fire, exhasted, out of breath, with your heart rate faster than the patients...you get my drift. Practice on anything you want so the steps of performing it are hardwired into your brain. Then do the human anatomy lesson. Until you do this on enough humans, you can't get "comfortable" with any procedure. Best of luck. Thought I'd give you one of my surgical/trauma quotes: "No one dies without an airway" ss __________________ '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) Last edited by swatsurgeon; 06-11-2010 at 19:07.
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