Quote:
Originally Posted by highspeedmdd
Well, here are my 2 pennies.
A lot of guys who are CLS qualified seem to think they know all about cric'ing someone.
They all seem to want to cut horizontally across the membrane in one fell swoop/ Good idea to cut vertical along the midline, seek out the membrane and blunt disect or cut once it is found. This helps prevent trauma to lots of vital organs and tissues.
Also, everyone seems to think you can breath through a strw or even a Skillcraft pen. Try it sometime. Doesnt work on a healthy uncompromised adult. It wont work on a patient. I told my soldiers to keep tubing in their pockets for special occassions.
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FWIW: When I wenth through, the 18d course was teaching the horizontal incision method. I believe it still is. (Correct me if I'm wrong). My understanding is that the advantage of this method is that its easier to keep track of the anatomical landmarks with this approach, as opposed to straying high or low after the initial incision. The vertical approach to cric also offers the danger of an unskilled operator damaging the thyroid. The horizontal approach also mirrors the lines of tension, although of course scarring is the last concern when a cric is being considered. The dangers of going too deep and lateral with a horizontal approach are mitigated by tenting the skin, rolling it between the fingers to ensure that no vital structures are trapped, and then making the superficial incision.
I have seen a resident physician get off course and nick an IJ on a vertical approach for a trach...
As far as I'm concerned either approach entails pitfalls if one uses poor technique and is not aware of the relevant anatomy.
BTW.... I'll add those "cric keyrings" we got issued a while back to the list of things that won't poke through a neck.
Agree 100% on breathing through a pen.