How to: Emergency Surgical Cricothyrotomy

[@PrepMedic]

Some of you need to hear this…. Never ever “improvise” a cric. Just because you saw it in a movie doesn’t mean it should be done. Furthermore, this video is to refresh the memory of trained responders and give non-medical personnel an insight into what the procedure entails. That’s it. Full stop. Don’t do this unless your scope of practice, protocols, state law align to allow you to do this.

[@jackblu475]

Never ever? my worst fear is going camping and someone with an obstructed airway and EMS is hours away... I know you cannot give *offical* medical advise, so theoretically speaking... I keep a scalpel and a pen in my mini first aid kit... I'm an EMT so this is outside my scope of practice, though if it was life or death for a family member I might resort to it... Hope I would not run into any legal issues in doing so, especially if things went south... Also, if something becomes this critical the pt will be passed out. After you perform the cric. will they begin drawing air by themself through the cric., or only sometimes? If they do not, and you do not have a BVM on hand, could you provide mouth-to-neck ventilation's for a family member as a absolute last resort as part of CPR until EMS got there? I'd rather have tried everything I could than just give up on someone and then always have wondered if I could have saved them. Especially family.

[@TheWackyRigger]

if things went south and you couldnt save the life i think itd be up to the court to decide whether you played a roll in the death, but there are also laws that are supposed to protect everyday citizens trying to help save lives, look up good samaritan laws and read them and maybe that will answer half of your questions, i am also an emt, definitely never ever do it on the job, thats for sure, but if its my family and im in a very bad situation with no ems, i would most definitely do everything i could out of scope to save them, just dont kill them when trying to help

[@jackblu475]

@@TheWackyRigger Im aware of good sam, I was a resident assistant at an ivy league for 4 years. Still pretty ambiguous overall. Thank you for your thoughts, I def agree that I would try to save them!!

[@TrueLimitness]

You beat me to it!

[@TimoNoko]

You need to make instructional video how to use ball-point pen correctly. When the patient tries to do it herself, it is clear indication that this procedure is necessary. It looks to me that you have to aim towards lungs. In the movies they just jam it in perpendicular, and it surely gets blocked by the opposite wall of the windpipe.

[@lieutenantdan8541]

Been a combat medic for about 3 years now, I have always found it hilarious how they train us on all of these interventions and combat skills, then throw us into a clinic as a glorified nurse for years on end

[@m118lr]

..HAS to be beyond frustrating though..?..’course what IN LIFE ISN’T right?

[@jarodduesing1728]

When I worked in a clinic I kept calling the medics nurses in my head :(

[@lieutenantdan8541]

@@jarodduesing1728 The army actually has an MOS just for nursing, 68C. They are trained for over a year to be nurses but the combat medic is used as a nurse most of the time

[@Liger._King]

They must feel very proud to be mistaken for nurses because nursing is no joke.

[@PrepMedic]

Lol

[@EWDAVID94]

Hey guys I got this. I saw a KZbin video on it once

[@Chongosworld]

😂

[@erikhoryza9068]

Having taken extensive CPR/First-aid, and some decent anatomy and physiology courses, this is doable. Without any training or knowledge prior, I would not feel confident in this aspect of lifesaving. I'm glad this is here if it's what I need to know if something happens to a friend or loved one. But I agree, don't use KZbin as certifiable knowledge, especially when it comes to strangers.

[@jamesesposito37]

😂

[@shanepowers7566]

Ha Ha Ha

[@ThePeterReyes]

Hahahaha

[@derekhill5893]

I’m an ER resident physician and work as a tactical medic as well. I’d add that unidentifiable anatomy isn’t always a contraindication. Severe angioedema, Lidwigs, some facial or neck trauma can all cause scenarios of can’t Intubate/can’t ventilate and necessitate a cric.

[@NavYblu99]

What're you aiming for at that point? If you cant palp the cricothyroid membrane that is?

[@SuperStonehammer]

26 years I concur

[@dutch-boy]

I barely understand this... I too concur

[@jonathanv8127]

It’s probably bc you’re protocol and medical expertise allows you to be able to do this right? I’d expect paramedics to not have this under their regulations, hence why he says unidentifiable anatomy is a contraindication. Or am I wrong?

[@NavYblu99]

@@jonathanv8127 It wouldnt surprise me to learn that "blind" (ie, cant palp the traditional landmarks) crics are within somebody's scope of practice. But as a lower level practitioner, I cant fathom how you'd go about cric-ing someone without being able to feel what youre doing. Hence my question.

[@JS-zb1vv]

Pig throats work really well for practice. We use those on our USAR team for training. Go to your local butcher get pig throats all the way to the lungs . Then you can put a plastic bag around the lungs and practice needle decompression too .

[@MrGattor33]

That's actually what i was trained on in my first semester of Medic school; and yes they do work really well.

[@OmarAbdulMalikDHEdMPASPACPAPro]

Thanks!☺👍🏾

[@Chris09978]

@@stevendeclercq3566 this is something that paramedics would carry in their jump bags or in their kit if they are a LEO medic, EMTs are not going to perform this procedure, and if you are a paramedic this stuff would mostly be in your jump bag, ambulance, and again if you are a medical aid LEO in your kit

[@VotEtoPizdets]

Pig throats work really well for throating.

[@silvinodino]

i use real humans

[@laszloszatmari2019]

I want to be a tactical medic at the hungarian special forces. AND THIS MEANS A LOT TO ME SO THANK YOU .

[@boom7713]

all the best, but i hope you will not serve under this nationalist government.

[@jamesryan2720]

All the best bro....from Malaysia.

[@greenlightforce]

Hoorah from across the world!

[@xxxlommo]

PrepMedic does a really brilliant job to educate people to saving life, I am here only for basics like tourniquet use and splinting broken limbs to be able to care about guys on the airsoft field, if something bad happens.I'm very happy to see other hungarians trying to educate themselves. I hope you will be able to be a tactical medic at the hungarian special forces, our country needs more and more professional soldier. ;)

[@vampirzak]

@@boom7713 I think You mistake Hungary with Belarus

[@Emjackson89]

I'm a former combat medic, I served in Afghanistan. While on patrol, i conducted a surgical airway under heavy fire. Casualty was then placed in the back of a moving tank as the LZ was too hot. The rear door remained completely open due to the stretcher being too long for the rear to close. As such, the door broke and exposed me and the casualty to enemy fire. The airway worked extremely well but a suction device was definitely a must, just in terms of helping you initially clear the airway prior and after the surgical airway. The velcro strap that secures it to the patient's neck isn't great in all conditions.

[@JamesSmith-ix5jd]

what happened? he choke when the taliban attacked?

[@uknwarrior7980]

@@JamesSmith-ix5jd I know 5 months later, but this procedure can produce a lot of bleeding. It can get messy especially in the situation where you've done a surgical airway under fire and the tube might not be the most perfectly secured device. I am assuming this is what he's talking about. Any time I've seen a surgical airway done it's always a messy procedure.

[@WilhelmFreidrich]

I want to thank you so much for this video. I tried this out on my cat yesterday, and it was a success! I really appreciate the information!! Keep it up!

[@markbegley1564]

hahahahahahaha ya nut hahaha

[@HUNTER-ve3iw]

Been loving the medical videos as a break from gear reviews, as an EMT who wants to become a medic and LOVES learning new thing, these honestly are amazing videos

[@heathenhalflings]

Don't wait mate....

[@glennekblad3958]

Excellent video. I have been the medical director for 3 helicopter systems, Including the 927th PJ unit. As a combat medice with the 25th Inf. Vietnam, I took care of a lot of GSW victims to the the head and neck. Always have a GSW victim sitting up and tell them what you are going to do. Find the landmarks, Make your first incision vertical. Make your cut through the cricoid membrane horizontal. Use a trach hook if you have one to lift up on the trachea for insertion of an ET tube (Cut back like in the video). Put a Bougie into the trachea and then railroad the ET tube over it. Use Tape the control the ET tube. If it is an alert trauma victim, let them decide how to breath. NO PARALYTICS, unless you cannot control the victim. Use IV Narcotics or Ketamine for analgesia. Col (Ret- Not) Glenn Ekblad, DO, MPH, MSN, FACEP. Anesthesiologist from U OF M. So What. Points. Control the airway first. Then give IV meds. Thank you to all of my "HIGH SPEED, LOW DRAG" Medics. GSE out

[@haroldi.6450]

🤓

[@egaluel]

Thank you for your service

[@wesnovak5336]

Thank you sir

[@tetontom1]

Guess I got old... what happened to using a dagger dilator for trachs, crics and may help in thoracostomies when blunt dissection is too difficult?

[@smokinmoose2]

I'll admit that at my age my memory isn't the best (and I'm sure that daily use of Gabapentin isn't helping), but I was a medic in Nam and seem to recall we used the tubes (or straws, if you will) from BIC pens. I don't remember having any new devices. Also, again, if I remember correctly, we used goat throats to practice on. And by the way, the pilots I flew with were certifiably nuts! But as basically a kid at that time I thought they were a blast.

[@GarthThomson]

This is the best tutorial I’ve seen on this topic. I’m a critical care helicopter paramedic with 30 years in the field I’ve been involved in 3 (all successful) of these procedures in the field. Great job @prepmedic 🏆

[@staceyb3882]

Only 3 in thirty years!? I’m 32 I just got out of hospital I fell off a ladder. The paramedic couldn’t establish a airway and he did a surgical cricothyrotomy on me after I read in my notes. It’s says I had desaturation to 6 percent in 90 seconds. Does that mean my oxygen was at 6 percent? this was performed after LMA and BM failed. This paramedic saved my life. Is it a high failure rate . I just feel sick to the gut. We’re you stressed doing this? We’re you ok afterwards?

[@GarthThomson]

@@staceyb3882 glad to hear that you have been able to recover from your experience! It’s what we refer to as a HALO procedure (High acuity low occurrence). As it’s an airway rescue procedure that’s performed when the patient is in a ‘can’t ventilate-can’t oxygenate’ situation failure to address the problem IR successfully accomplish this procedure would likely result in increasing hypoxia and ultimately brain injury and or the patients death. Oxygenation can fall rapidly but pulse oximeters used by medical professionals to monitor blood oxygenation levels become unreliable below 80% so the numbers you are quoting don’t really make a lot of sense to me but hey the important thing is that your Paramedic identified the problem and the solution and acted accordingly. It’s a stressful situation but we’re trained and assessed and the procedures are reviewed regularly so as to ensure we are competent and confident when called upon to assist people in your situation and the like. I was fine, though relieved each time it is actually quite a rewarding experience when the patient has a good outcome as is your experience. Stay well eh 🤙

[@Clvaner]

i'm a student paramedic in the UK and found this video really helpful, thank you for putting in the effort to make this video happen :)

[@NikosKatsikanis]

any crash courses in the UK for larpers?

[@pauldean8638]

Keep with it mate , just think you serve the nation not the imbeciles in power , we all behind you getting better wages

[@m118lr]

Very informative. Not an EMT, etc but fascinated by the med world and VERY thankful for those professionals (Such as YOURSELF) and techs in the field! Thanks..really appreciated

[@scottmattoon9054]

Great job! Im an ortho PA now and a combat airborn medic veteran not combat veteran. The way things are going I want to be ready for as many problems as possible. Thank you for the refresher.

[@mingisreal]

you were born in the air???

[@PrepMedic]

**Murphy's Eye, no Islets of Langerhans** my mind was stuck on cellular anatomy for some reason.

[@renegade7493]

No worries. Thanks for all these videos. Happy Easter

[@Rickardsson99]

What is your opinion on using tracheal hooks? I think they are good since there is no chance to lose the airway once it is inserted. And you don't have to mash your finger into the fellas throat.

[@Jack-bp3ns]

Will blood fill the lungs of the Incision site? Or will it not be a substantial amount to worry about

[@Rickardsson99]

@@Jack-bp3ns If you avoid the thyroid gland the bleeding will be managable. The patient will also exhale some of the blood. Speed is key with a cric. Blood pooling in the lungs is not very conducive to a clean airway. Here is a great video for showing a live cric [GRAPHIC CONTENT]: kzbin.info/www/bejne/Z5qzg6WwhJdpm6s

[@BassReeves24]

Was just about to comment this!

[@pinoy413]

Respiratory Therapist here. Well done!

[@energizedlove4228]

How often do you do this as a respiratory therapist?

[@pinoy413]

@@energizedlove4228 We're trained to do it, but we don't. If its planned, ENT doc or Pulmonary doc does it. If it's emergent, ER doc will handle it.

[@energizedlove4228]

@@pinoy413 do you intubate or does the CRNA?

[@willispautz]

@@energizedlove4228 RT’s Intubate

[@PrepMedic]

RTs can intubate but it is pretty rare for hospitals to allow them to do so.

[@EliasHernandez-ov2jz]

I just found your channel, I’m a former active duty Marine thank you for these videos, as a veteran it’s comforting to have a resource to refresh on this type of training.

[@deborahkelly1489]

Thank you for your service sir . Once a Marine always a Marine . The Few The Proud !!

[@hollywoodjoe67]

Semper Fi brother....Rah

[@5minuteemsreview216]

This reminds me a lot of Scott Weingart’s scalpel, finger, bougie presentation on the EMCrit podcast. This is a very well done video on the topic. Nice work.

[@donthequail5278]

Great video. One point - the bougie typically does not stop ("hold up") at the carina, but typically it keeps going into the right mainstem bronchus and holdup happens in some large airway on the right. The carina is very close to the cricothyroid membrane -- so the bougie will go well beyond it, and you have to be careful about only putting in the ETT (if used rather than trach) only so the balloon barely disappears.

[@OmarAbdulMalikDHEdMPASPACPAPro]

Hi. I'm Hospitalist PA in Washington, D.C. I subscribed. What a WONDERFUL channel. You're a good teacher.👋🏾👨🏾‍⚕️

[@richhajdu8150]

Very interesting seeing the procedure done on a practice piece. I'm a pediatric trach/vent nursein homecare obviously as an LPN we can't do the procedure but we do have orders from the doctor as to how often to change the tube and emergency orders for when it comes out. So I put in quite a few trach tubes also had two of my patients pull their tube out which unfortunately results in respiratory arrest. Luckily we have orders allowing us to stabilize and monitor in the home and if no improvement we send them to the hospital (I've been lucky both times the patient ended up fine and it was resolved in a minute). Thank you for the great video.

[@joestevenson5568]

Tracheostomy is not the same thing as cricothyrotomy.

[@michaelgilroy1277]

Was a combat medic back in the 70's and was taught that second method only (your helicopter method). Thanks for the great info.

[@BrysonBurgess2007]

Great video Sam, I want to be a Paramedic so your videos are very helpful!

[@ericnorthwood9182]

The eyelet on the end of an ETT is called the Murphy Eye, named after a Dr Murphy who designed the ideal endotracheal tube. Islets of Langerhans are endocrine cells found in the pancreas. Thank you for the video, I feel a lot more prepared for my upcoming wet lab class!

[@johne1653]

Having been a paramedic with a bit of experience, we had Nu Trake Kits in the airway bag, along with catheters to do peds cric's, Introducer guide wires to perform retrograde intubations when the anatomy is disfigured from trauma. In 8 years on the street I used the Nu Trake Kits 2X. Back then they were expensive. Needle crics work well a large bore IV catheter using them with small peds ETT uncuffed you take the bvm attachment off the ETT and then it fits right into a large bore iv catheter hub. Or as pointed out the drip chamber from an IV set up. The first time using a Nu Trake I hesitated a bit too much, and it was bloody mess. The 2nd time was better. But, lab work has changed over the years providing practice. The thing about skills is that they have to become a "thoughtless" reaction to a given circumstance. Because if the patient is not breathing well you are toasting their brain! If you ever want entertainment.....work in a large teaching hospital with residents and interns scratching their "SIX".... Especially around the time each school year starts! Not demeaning Flight Medics or Flight Nurses, but they are not God's. Yes, many have an expanded scope of practice as granted by their medical director. But, if you study patient treatment protocols there are some very aggressive protocols for ground and flight teams alike. And, there are some restrictive EMS systems, too. EMS is wonderful world.

[@Favorite-catNip]

I worked with a military hospital medic getting up in years. This guy was a no nonsense blessing. However he was hired as civilian and checking credentials didn't fly with ADMINISTRAtion. They transfer the guy to immunization clinic. So sad to see him get reassigned. Grt. Video.

[@fitnesspoint2006]

LMAO "residents and interns" wait about 1 year when a typical surgical intern has 300 operative cases (including 50 crics) under their belts just to move on to the second year. Then another 300 cases are needed to move onto the 3nd year and they will run circles around your 5 Nu trakes.

[@PrepMedic]

You are mixing up your terminology. A cric and a trach are two different procedures

[@russellmcelreath7918]

Very well instructed...was a sports medicine staff member as a student in college, worked the football practice field. Instructed by team physician during seminar. Much clearer now...thanks!

[@bridgetownforge4255]

Very well done video. Reinforced my previous training. Thanks!

[@dougww1ectebow]

Good video, have done a few of these but this is a good refresher. I was trained on method #2, and have always done them that way.

[@eddyballester8990]

Thanks again Sam and particularly for mentioning the options... regards.

[@eddyballester8990]

did you intend to say Murphy’s eye and not islets of langerhans? Pardon if I misunderstood

[@PrepMedic]

Lol. You are absolutely correct. I misspoke and didn’t even notice

[@eddyballester8990]

@@PrepMedic happens to all of us.. we talk about multiple subjects frequently and that kinda thing happens. You do a wonderful job and service for our profession and it’s very much appreciated! Tried contacting you directly, but am not very familiar with navigating thru this forum. Thanks again Sam, regards!

[@axemanlion3475]

This has helped me understand soo.. much more. If I had to do, I won't have your equipment, but the beautiful principles you showed, could help me save a life. Thanks for saying "infection can be dealt with later", that gives me more confidence. I've got deep vein thrombosis and canned oxygen helped me this past Sunday, with heart clots. I know what oxygen deprivation feels like and I need to know how to help others. Thank you very much for teaching us

[@thomasb.581]

Unless you're a trained medical professional, please don't perform this procedure. Take a first aid course near you to learn how to save a life preferably. Have a nice day.

[@axemanlion3475]

@@thomasb.581 not all of us have time for courses and yes, I would always want a professional, but in South Africa, we don't always have the luxury of that and criminals are all around. Sometimes we're just trying to stay out of trouble. Really sad Sometimes, the untrained have to help and courses are not easily accessible to all. Be safe and help those around you 🥰

[@florianrausch3607]

The way I learned it at the TECC course was quite similiar to the first way in the video. But instead of using the finger we used a nose speculum to blunt dissect. The service I'm currently working for provides regular et tubes for the procedure. But hontestly being an EMT* I highly doubt, that I will ever perform it. Anyhow great very informative video! Grettings from Europe! *German/Bavarian equivalent "Rettungssanitäter", at least 520hrs of training

[@Medicbobs]

Did my first one on a motorcycle wreck the other night. Definitely have some guaze ready as it's going to bleed some. I inserted the bougie prior to pulling out the blade and everything else went fine. It's definitely scarier to think about than when you do it. Good video though!❤

[@zekemendoza7343]

Best video so far! I’ve been waiting for this one! One of the coolest things medics can do

[@HillbillyHen]

i pray to god i am never ever in that situation but your video was very informative and honestly if i was in that situation although i would be stressed to the max i feel i now have a better understanding of what to do to buy me critical time until i could get professional help and give me a fighting chance for a good outcome - thank you soooo very much

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general better ways to help someone who's not breathing than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@thomasb.581]

@Brandon Wellington It's not necessarily a little dick syndrome, it's rather about saving lives with the procedure one performs instead of causing additional pain and possibly either injuring or killing a patient. Also due to risking a possible lawsuit for a highly invasive procedure like this, depending on which state or country one lives in, I can't recommend doing this. There is a reason that only medical professionals do this, normally always with medical equipment.

[@staceyb3882]

@@thomasb.581but if they don’t try it the patient will go into cardiac arrest so what have they to loose

[@jeffreykramlich3784]

Have you ever heard of using an IV drip chamber? After the procedure your BVM fits perfectly on it.

[@stefangustafsson1708]

Im not sure all drip-chambers are the right size. I tried a mock-up with a 20 drop/milliliter set and it did not fit the BVM. Possibly a 10 drop-IV-set will work.

[@UnfilteredMedic]

I did this on a cadaver and inserted a chest tube after doing advanced EMT training in the Army. Advanced Airway Tx is not easy. Like any medical skill some have a talent for some while others require practice.

[@st05002125]

Top job with the video! I too have been taught your HEMS technique, with the first option for those that you can’t palpate so easily. Not a skill I’ve had to use yet so this will be handy to refresh periodically.

[@nottthereyet4872]

Good question. Very interested in this and other life saving procedures

[@akimbo5u]

Thank you for this great video, Im a critical care PA and found this helpful

[@sana-cm7oc]

Great video. We were taught the second technique with the option of inserting a small laryngoscope into the hole to open it and for illumination. We also cut the ETT but do it at a slight angle to make it easier to replace the ETT adapter.

[@samsgro1127]

Interesting, I haven't seen the laryngoscope done, but it makes sense.

[@MrCrimenews]

I did this procedure with a pen knife and ball point pen barrel in Germany on a civilian as an Army medic in 1968. I had no medical supplies ie, trach tube. It was terrifying! It was messy but it worked! A German ambulance arrived and the crew actually had an ambubag! I taped the ambubag to the pen to seal the new airway. The sound of rushing air of that perhaps 10 MM pen barrel was both encouraging and scary. The patient survived! Thanks for this presentation. I would have tried the Hemlich Maneuver but that was not yet known. This happened in a restaurant and I suspected meat blockage. Yes, the meat obstruction was located and removed at the German hospital ER. I also suspected he may have had a serious food allergy but that was not the case.

[@PewPewFreedom]

Thank you for the demonstration. I'm always fascinated by surgical procedures and this video definitely helped me to understand the procedure and importance of this life saving skill. Prep medic, where can I buy these training tools that you've used?

[@Giltr0y]

Thanks! Definitely going to try that on my colleagues tomorrow at work.

[@medic4life1]

When I was taught we used a nasal speculum. Which we used like a tracheal hook but also as a spreader. Worked well also.

[@huxleyorwellrand3137]

Hope you guys realize the value you are providing. And motivation.

[@jonathanperazzo]

I almost had to do this to my wife with a straw and a steak knife. Thankfully, the need was averted, but this video confirms I would have done a pretty good job despite having ZERO prior training. Great video. Thank you for posting it.👍🏻

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general better ways to help someone who's not breathing than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@eddanaa]

oh yeah im sure man

[@thomasmacginnes100]

thee are procedures whichshould be incorporated in grade schools according to the developmental assessment of the children. Emergency Medical skills are essential for all to be given at the appropriate time of maturity and skill sets exhibited. Thank you for your up to date on a Cric!

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@Sniperboy5551]

I could see that going very poorly. The average person isn’t very bright and half of the population is dumber than they are. Of course some people could benefit from learning something like this, but I don’t want idiots going around thinking that they can do something as invasive as this. Too much room for error.

[@bruhmoment1835]

Yeah please don't train children in surgical procedures

[@johnbaugh2437]

I’ve done 4, all successful, without significant hypoxia (upper 60’s in lowest one). The biggest thing is to do it as soon as you realize you can’t ventilate or intubate. Don’t wait till you have a dead patient. I’m an ER doc. There is no ideal circumstance, and no one gets enough experience. You are the most experienced person. There will be a lot of blood. Your hands will shake like crazy after. I use a bougie and a 6.0 ETT.

[@staceyb3882]

This is all scaring me so much. Someone must of been watching over me. I’m 32 and just had one of these 14 days ago when I woke up in icu they told me paramedic saved my life. I hope he is ok

[@vibratorpinata]

@@staceyb3882Don’t forget to sue! The paramedic probably wasn’t licensed to perform this procedure so you should have an easy case to make.

[@vibratorpinata]

@@staceyb3882Don’t forget to sue! The paramedic probably wasn’t licensed to perform this procedure so you should have an easy case to make.

[@shiningstar8844]

Thank you so much sam you're incredible l I'm following you from Arabic country ♥️

[@garyweber7139]

Also I would check the balloon for patency before beginning the procedure. Yes it's rare for a balloon to have a defect but it has happened to me a couple of times in my career, more often with Foley catheters which is a completely different subject.

[@hairyparatestes1183]

I remember an episode on MASH where Radar was doing the 2nd version of this procedure (single cut side to side) under direction from Hawkeye via 2 way radio and Radar used a pocket knife for the incision and a pen tube to provide the airway.

[@Ukmongoose3]

I saw this!

[@ralphbove]

Nice job. Was a RN/Medic on a helicopter for 28 years. Probably only did a dozen my whole career thank God. One thing I will add is make the cut big enough. My first few I was worried about making a nice tidy clean small incision. Makes your life far more complicated especially when you got someone with a large or fat neck or a huge amount of swelling. Think of the situation you are in. They will have plenty of time back at the trauma center to sew that neck up if the patient survives. OPEN that skin and tissue up so you can cut that membrane. I would "pop" the scalpel through the membrane. While the scalpel was still through the membrane I would insert my Kelly clamp in the hole and then take the scalpel out. I would use the Kelly's to open the membrane significantly. I would then slide my finger along the Kelly and into the hole. Don't take your finger out of the hole. I have used ETT before but even cut they are a pain in the arse to use and secure. I always found a #7 shiley trach worked the best. I never needed a bougie as the Shileys have an obturator that will allow you to slide the entire Shiley right in. Bury it and then pull the Ob out. Slap on your End tidal and bag and you should be good. The other part I loved about the Shiley is the head strap that comes with it. No matter how much blood, puke or bone you can always get that strap around their neck and velcro and clips hold awesome. Last tidbit I will add is I landed on a scene once where a crich was already performed and they were having a heck of a bagging the patient. What had happened was the person had such a fat neck that they lost the hole and put the tube into the subQ tissue and were trying to bag into the tissue. Its really easy to lose your way on the huge necks. I just opened the cut much bigger and then was able to find their original puncture which was good and feed the Shiley into it. Good luck and stay safe out there.

[@tuckerbeene1606]

Idk why you showed up on my recommended but I’m glad you did your awesome man

[@davidplowie4670]

You said you inserted the bougie tip into the islets of langerhans.... The Pancreas? Guessing you mean the Murphy Eye? ;) Edit: Ooops should have read the comments lol

[@shaneyates2608]

Thank you very very much for making this video I just learned something very valuable so thank you very much for sharing I've always wondered how this procedure would be done if need be I am so glad that I watched this video and I subscribed like and share but take care and God bless

[@crimony3054]

I'm learning to be a surgeon entirely by watching KZbin videos!

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who's not breathing than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@ayl5405]

🤣🤣🤣💀

[@virtuaguyverify]

I feel like I'm ready to do a heart transplant

[@Argonikron]

I can now create an artificial human by watching youtube videos.

[@stuffesen]

Thanks for a great video! It''s really important to train this procedure regularly since you will probably only do it maybe once or twice in your career. I can only think of one thing to add (although it doesn't really apply to your model): Remember to extend the patients neck all the way back to better expose the structures before cutting.

[@toddcarpenter714]

If you aren't trained and certified, any invasive medical procedure puts YOU at risk of a huge law suit! I was a certified paramedic, but I'm now retired, my certification has expired. So for me to attempt anything like this would be ludicrous!

[@LK-bz9sk]

A very important comment for all of us to read. Even if proficient at this, the litigious nature of this country would give me great pause

[@gotto_beo7069]

I fw this your doing a good thing giving us citizens that don't have immediate access to ems at least a chance Incase it is a critical moment and there's no time left

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@jsthecanuck6804]

**my face when struggling to breathe as a man comes to my aid only to realize the horror in his words when says "I'll help, i saw this on youtube!"** 💀💀💀

[@hollywoodjoe67]

I just want to suggest something as a patient with severe obstructive sleep apnea...Ive had a Montgomery tube Stoma Stent since 2004 to treat same...I had gotten a pseudomonas infection and would much rather see a clean hook being used than a finger...I totally get in a combat environment, you may have seconds to complete the procedure in which case get it done...Having also been a US Marine, I highly understand those situations. Just wanted to give some first hand food for thought...Outstanding job on this video

[@wesman7837]

I wish you would use layman terms to explain a down, and dirty how to save your buddy when time is of the essence, and for us that don't have any medical training. Please give the reason(s) we would need to do this.

[@nitroxylictv]

Very horrifying but I can appreciate the extensive and ludicrous training that goes into creating these types of procedures. So many people have been saved by these things.

[@Tief1ght3r]

Step 1: Don't. Step 2: No, really. Don't. Step 3: This is not a movie. Just don't. Step 4: If you really must, let it somebody do, who has proper training (e.g. not YT university).

[@clueken13]

Dude, you’re a hero! Mad respect 🫡

[@sw640]

ive heard about these procedures being done with a ballpoint pen, seems highly unlikely

[@scottmcalister2091]

Thankyou brother for all the refreshing info been a while since I did all this.

[@Donnybrook10]

good vid. We learned blind digital intubation under fire...complete dark, bullets flying over head. It was intense.

[@SmokysRides]

George Clooney taught me how to do this on ER in the 90s. Thanks George! Still haven't needed to try it yet though.

[@keithkersten5586]

Great presentation and thank you

[@Grady00683]

You channel is saving lives my man. Thank you.

[@ClinicalMedicoSchool]

Amazing point 👍

[@tone19xx]

I'm a stoner from my house and I want you to know this video blew my mind, man.

[@MrAndyCarlos]

I do not know anything about medical procedure and I'm watching it.

[@republikasrpskagaming7436]

im going to northern london in a week this will help very much thank you

[@staceyb3882]

I am 32 years of age in Victoria Australia . I would love to hear from someone anyone who has had this and how are you now? I’m traumatised mentally . I woke up 14 days ago and remember trying to talk they said Stacey you have a tube down your mouth you can’t talk we are about to take it out. Anyway I than heard what had happened and why I was in a coma for 2 days. Ambulance arrived they couldn’t establish a airway . Saturation drop 6 percent in 90 seconds. They performed a emergency cricothyroid procedure. Than apparently when I got to ed it was transferred to a tracheostomy. All I remember the 10 days I was in hosptial is how lucky ambulance saved my life. I know I should be appreciative but I feel sick to the gut of the paramedic assigned to me that day maybe hadn’t of done one before? On my discharge letter it States I had a collapsed lung and Subcutaneous emphysema.

[@Favorite-catNip]

Excellent visuals. Thx. Very much. I would pre^thread a trach tie on one side or actually preposition the tie under neck and reconnect afterwards. This is well done. Cant imagine how much blood would be involved. I once reviewed a video from John Hopkins years ago. About sterility of bedside tracheotomy. It was a great video. Thx.

[@akabhi170]

Works very well with my Dog, thank you KZbin doctor 😊

[@themiscreants3337]

This came recommeded into my feed; You seem very, very skilled. May I ask, what are some of the potentional implications/complications if this procedure is not executed properly in terms of damage to the patient? Thanks again; Great video.

[@charles118]

Thanks for the reminder , i just have one question. I first learned the gest in doctor house with a pen , i wonder does it works with pencil ? Thanks

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing the Heimlich Maneauver or Chest compressions can be a better idea depending on the scenario. I hope you'll have a nice day.👍🏻

[@MrGattor33]

Hey Sam great video. Good little prop you got there. Now my question for you is, why couldn't you inflate the air cuff around the CRIC tube prior to removing the bougie so that way the tube will not come out? Again great video demonstration on this technique!

[@Favorite-catNip]

I'm thinking limited space Inside the trachea. And since its probably bloody the patient may have moved a smidge.partial Inflation would actually limit air supply. I think.

[@john1182]

youtube has been pushing this video on me for a solid 6 months, yes ive done some EMS and emergency service work but can i legally and will ever do this no. bot i give in youtube i shall get a beer and sit down and watch and like.

[@Brandonwalsh18]

You should do a video discussing critical care procedures for head and spinal injuries.

[@chrismcgee7177]

Absolutely Totally Awesome Video Thank you so much for this video.

[@IWH777]

TY TY TY THIS SO WONDERFUL TO KNOW JUST IN CASE SOMETHING CRAZY COMES ALONG AN NOBODY WILL STEP UP TO DO THE RIGHT THING... FANTASTIC VIDEO SIR THANK YOU AGAIN

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who's not breathing than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@IWH777]

@@thomasb.581 RIGHT/CORRECT; BUT ITS STILL GOOD TO KNOW THOUGH

[@marcosadomaitis6349]

Congratulations, from Brazil!!! 👏👏👏👏👏

[@Dreadzilla]

17:22 - I’m so glad that you clarified the Islets of Langerhans/Murphy’s Eye mixup in the description 😂 I’m a registered nurse (not trained to perform this procedure!) and was wondering what these fancy little pancreatic cells had to do with an ET tube 😂 I didn’t know the anatomy of an ET tube, but I knew that didn’t sound quite right! 😅

[@lstnlne7399]

with no bovie or nitrate sticks? yes it is done in the field all the time 33 yrs in trauma surgey tons of call leasee ur giving others good advice- how do you stop the bleeding ? in the OR or at bedside we had a bovie machine.

[@atypicalviking1369]

This guy is so badass! Thank you Sir.

[@vdub7090]

This is one of those things you wanna know how to do before you need to know how to do it. Thanks youtube suggestions!

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@CanIbeWithThee]

Easy peasy I'm ready to go! Thanks for the education!

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@sandysmith9869]

I'm going to try this on my cat. Great video.

[@virtuaguyverify]

I don't have a cat. Do you have another cat?

[@FM-ig3th]

Tip: Use a No. 11 Blade. You can also cut down a size 6.0 ETT to use the ventilate the patient with a BVM.

[@buzzsah]

Good vid, well done. However, for a new, off the street person that never done this, what would be the reason to perform this ? Again well done.

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill them if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@BandidoDeOtin]

Thanks for the great instructional video. I also prefer the first technique with the vertical incision. Especially in challenging airways it is easier to palpate the landmarks after skin incision. I‘d like to know how often do you all actually perform a cric. As a simulation trainer I do simulated crics on a regular basis. But in 20 years practicing anesthesiology as a physician I only needed to perform a surgical airway once.

[@PrepMedic]

Surgical airways are a bit more common in the prehospital environment simply because of the hyper-acute issues we respond to. That being said, they are still rare. I have done 1 in 10 years as a medic. My department does 3-5 a year.

[@carlosruizmora3111]

Hi, has this procedure ever been practiced on a concious patient. If so, how traumatic is it for him/her? What I am to figure it is if the pain is bearable or excruciating. I am asking this from the point of view of a patient, try ing to understand what I would face if this is ever practiced on me. Thanks for such an informative video.

[@JamesSmith-ix5jd]

No way you can lay still knowing you are about to die and can't breathe. If I knew there is someone around who can do this procedure and has everything ready, then maybe I would be able to pass out without too much fuss.

[@TheBlackadder-Edmund]

I am a Pothole maker (you would think people would avoid Potholes but they just go straight for them and... oh well...), and cant tell you how many times I whish I had a "Emergency Surgical Cricothyrotomy For dummies", this video is exactly what I needed. Just some feedback, could you do one of those 60 seconds videos for this? 20s would be better...

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure. A first aid lecture and first aid in general provides better ways to help someone who's not breathing than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing chest compressions or the Heimlich Maneuver can be a better idea depending on the scenario. I hope you'll have a nice day.

[@TheBlackadder-Edmund]

@@thomasb.581 Hello, nowadays medical professionals have a vast array of learning resources at their disposal (the challenge could be too many, at least in the countries that i know of). Therefore, even if the content creator may be well intentioned, a "how to" for this on Facebook is, in my opinion, not the best demographic (even if he adds disclaimers as he has). Note i am referring to the "how to", an opinion or research results could be very instructive. Merry Xmas :)

[@fernandog.1575]

1:00 😂 like in the film “The Heat” with Sandra Bullock and Melissa McCarthy. Man, that got me…

[@cassanoa]

this is useful information for someone who is actually carrying special gear like the one you showed but most people will probably not even have a pocket knife - i was expecting some type of emergency street level demonstration someone could do if it was immediate danger - before medical help arrives - are you doing these videos for medical professionals ?

[@cassanoa]

@@BlindGirlUK exactly- I hope never but in a emergency one might have to

[@thomasb.581]

@@cassanoa Please don't try this in an emergency unless you're a medical professional trained and educated in this procedure.

[@cassanoa]

@@thomasb.581 believe me I don’t want to ever be in such a position but what do you do if there is no other choice - waiting for help could mean someone’s life

[@PrepMedic]

This is not a procedure you do without formal training. Follow BLS choking guidelines.

[@cassanoa]

@@PrepMedic yes thank you Basic Life Support procedures - but who is this video for ? Someone with your skill level already knows and Carrie’s the kit

[@ClinicalMedicoSchool]

Also show alternative equipments because any specific medical equipment may not be available on the spot

[@thomasb.581]

This procedure is only for medical professionals and people specifically trained in this procedure like paramedics. A first aid lecture and first aid in general provides better ways to help someone who is not breathing, than to do something this invasive with a knife or a scalpel with which you could easily injure the patient additionally or kill him if not done correctly. Performing the Heimlich Maneuver or Chest compressions can be a better idea depending on the scenario. I hope you'll have a nice day.👍🏻

[@JLawL]

You get to do a lot of fun things as a Ranger, like perform a trach whilst running behind the person carrying the patient you're about to perform the trach on.