Thursday, May 17, 2012

The Papermate Flexgrip Cricothyroidotomy

Emergency Medicine has more than a little MacGyver instinct to it - and one of the semi-urban legend aspects of EM is the ability to perform a cricothyroidotomy as a life-saving measure in any situation.  The most commonly described version is performed using simple, commonly available tools - any sort of cutting blade and a hollow tube, such as a hollow pen.

Several studies have approached feasibility by describing the flow dynamics of various pens, but this is the first study to evaluate the procedural feasibility of bystander cric.  This is an observational, cadaveric study using non-EM junior physicians and medical students in which they used a 26-blade scalpel and a Papermate ballpoint pen of 8.9mm external diameter to attempt an "off-the-cuff" cric.  The 9 participants attempting 14 procedures were successful 8 times, although complications were frequent, including vascular and muscular/cartilaginous injuries.

Whether this is externally valid to the living, or to patient-oriented outcomes of effective ventilation, I'm not so certain - but, then again, if the alternative is 100% mortality via no possible ventilation, it's a fun study to see.

"Observational cadaveric study of emergency bystander cricothyroidotomy with a ballpoint pen by untrained junior doctors and medical students"
http://emj.bmj.com/content/early/2012/05/04/emermed-2012-201317.short

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