Crich vs. Trach

Fri Apr 4 15:42:16 BST 2008

All-

A cricothyrotomy is a life-saving procedure that we, as ALS providers,
should be able to confidently place in any time, place or situation; with or
without "special" gear.

To put this argument into perspective: the cricothyrotomy is one of two ways
that is presently taught to medical and NON-MEDICAL operators to manage a
compromised airway in the military Tactical Combat Casualty Care program.
Their environment is a bit different than yours to be sure--fewer resources,
less training, less than ideal environment--but the requirements are the
same.  We have found that after training, these folks have a high rate of
success on first attempt placement when tested in their environment.  Airway
compromise is the 2nd leading cause of death on the battlefield.  Therefore
this is an important capability for ALL of our troops to possess because it
is very likely that the medic will NOT be there (or will BE the casualty)
when the injury occurs.  To add more fuel to this fire, this is not a
provider-level skill; remember in the "bad old days" a cric was the
last-resort standard taught to EMTs and Boy Scouts as a portion of their
programs.  

The issue all boils down to one thing: training.  Like it or not, tissue
training is an absolute necessity to ensure success with this procedure.
The amount of stress, the physiological changes observed and all the other
pieces come together for the "operator" during this type of training unlike
anything else that is presently available.  No amount of "Mr Hurt" (or any
other) simulator time will make up for the amount of confidence that tissue
training provides.  Think about it this way: in the military training, our
troops are successfully able to place a cric in the dirt, on their knees, in
the dark, wearing body armor and a helmet.  There are many AARs where these
non-medics have (without benefit of additional training) successfully placed
a cric IN THEIR TEAMMATE, under fire.  It also goes without saying that
training needs to be done regularly as the more your folks are "stress
inoculated" the better their performance.

Special cric (percutaneous) kits are fine if you have the space and weight
for an item that only does one thing AND the time to train on that
equipment.  In training, however, the basics--how to complete the procedure
properly with a knife and tube--should be emphasized.  At some point, you
will not have the specialty gear when it's required, so be prepared.

Just some points from the field.

Respectfully-

Chris Pipes
Director, Special Projects
Deployment Medicine International  

-----Original Message-----
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On Behalf Of trauma-list-request at trauma.org
Sent: Friday, April 04, 2008 4:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 58, Issue 4

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Today's Topics:

   1. RE: article request (Paul.Harrison at sth.nhs.uk)
   2. Nader Habashi (OT) (Keith D. Lamb)
   3. RE: Nader Habashi (OT) (James Richardson)
   4. RE: Nader Habashi (OT) (Theresa Dinardo)
   5. RE: Cric kits now & then... (Marc Matthews - MedPro MMC X)
   6. Re: Cric kits now & then... (Ivan Hronek)
   7. RE: Cricothyrotomy vs.tracheostomy ? (McSwain, Norman E Jr.)
   8. Cricothyrotomy vs.tracheostomy ? (Ivan Hronek)
   9. Re: RE: Nader Habashi (OT) (Daniel R. Hill)
  10. RE: Cricothyrotomy vs.tracheostomy ? (Bill Griggs)
  11. Re: Cricothyrotomy vs.tracheostomy ? (Mathias Kalkum)

----------------------------------------------------------------------

Message: 1
Date: Thu, 3 Apr 2008 13:17:15 +0100
From: <Paul.Harrison at sth.nhs.uk>
Subject: RE: article request
To: <trauma-list at trauma.org>
Message-ID:
	<505D97789E52734987A451E86FBDD806FB090E at NGHEMAIL1.sth.nhs.uk>
Content-Type: text/plain;	charset="us-ascii"

Before you go anywhere else - go here:

http://www.campaignforcure.org/

Paul Harrison
Clinical Development Officer
Princess Royal Spinal Injuries Centre
Sheffield UK

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of candymsnjd at aol.com
Sent: 03 April 2008 11:01
To: trauma-list at trauma.org
Subject: Re: article request

does anyone have a?site i can access the new ACEP guidelines for
steroids in acute SCI??
thanks much

-----Original Message-----
From: Mathias Kalkum <listen at doc-kalkum.de>
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Tue, 1 Apr 2008 2:28 am
Subject: Re: article request

Charles, Daniel,?
?
> The Mt. Sinai Journal of Medicine has a website which contains the
current issue, as well as previous issues. The website is
http://www.mssm.edu/msjournal/back.shtml If this link does not work, I
have uploaded the article in PDF format.?
?
interesting read. I wonder if a paper telling us that "MAST pants has
been shown to benefit patients in hemorrhagic shock" and that
methylprednisolon is of benefit in spine trauma is doing good represents
?today's wisdom....?
?
Cheers!?
?
Mathias?
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Message: 2
Date: Thu, 3 Apr 2008 08:50:54 -0400
From: "Keith D. Lamb" <lambrrt at gmail.com>
Subject: Nader Habashi (OT)
To: CCM <ccm-l at ccm-l.org>
Cc: Trauma & Critical Care mailing list <trauma-list at trauma.org>
Message-ID:
	<d8e5d9b0804030550k3cfe8f1am5a4b05da8405453 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

Does anyone have contact information (e-mail and or phone number) for Nader
Habashi at Shock Trauma in Maryland?

Thanks,

Keith

Keith D. Lamb, RRT
Department of Respiratory Care
Christiana Care Health System
Newark, DE
302 983 6178

------------------------------

Message: 3
Date: Thu, 3 Apr 2008 06:56:35 -0600
From: "James Richardson" <jimmnn at comcast.net>
Subject: RE: Nader Habashi (OT)
To: "'Trauma &amp; Critical Care mailing list'"
	<trauma-list at trauma.org>
Message-ID: <001201c8958a$2f47f6d0$a9addb46 at richardson>
Content-Type: text/plain;	charset="us-ascii"

Google is your friend.

http://www.wellness.com/dir/2189404/internist/md/baltimore/nader-habashi-sho
ck-trauma-assoc-pa-shock-trauma-associates-pa-md

Jim< 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Keith D. Lamb
Sent: Thursday, April 03, 2008 6:51 AM
To: CCM
Cc: Trauma & Critical Care mailing list
Subject: Nader Habashi (OT)

Does anyone have contact information (e-mail and or phone number) for Nader
Habashi at Shock Trauma in Maryland?

Thanks,

Keith

Keith D. Lamb, RRT
Department of Respiratory Care
Christiana Care Health System
Newark, DE
302 983 6178
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------------------------------

Message: 4
Date: Thu, 03 Apr 2008 09:32:20 -0400
From: "Theresa Dinardo" <tdinardo at umm.edu>
Subject: RE: Nader Habashi (OT)
To: "'Trauma &amp; Critical Care mailing list'"
	<trauma-list at trauma.org>
Message-ID: <47F4A49D.16A5.00F3.0 at umm.edu>
Content-Type: text/plain; charset=US-ASCII

Nadar Habashi
nhabashi at umm.edu 
22 S. Greene Street
Baltimore MD 21201

>>> "James Richardson" <jimmnn at comcast.net> 4/3/2008 8:56 AM >>>
Google is your friend.

http://www.wellness.com/dir/2189404/internist/md/baltimore/nader-habashi-sho

ck-trauma-assoc-pa-shock-trauma-associates-pa-md

Jim< 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]

On Behalf Of Keith D. Lamb
Sent: Thursday, April 03, 2008 6:51 AM
To: CCM
Cc: Trauma & Critical Care mailing list
Subject: Nader Habashi (OT)

Does anyone have contact information (e-mail and or phone number) for Nader
Habashi at Shock Trauma in Maryland?

Thanks,

Keith

Keith D. Lamb, RRT
Department of Respiratory Care
Christiana Care Health System
Newark, DE
302 983 6178
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------------------------------

Message: 5
Date: Thu, 3 Apr 2008 06:44:28 -0700
From: "Marc Matthews - MedPro MMC X" <Marc_Matthews at medprodoctors.com>
Subject: RE: Cric kits now & then...
To: "Trauma &amp; Critical Care mailing list"
	<trauma-list at trauma.org>,	<ccm-l at ccm-l.org>
Message-ID:
	<28907859B728CA469FCD77AB2DBB10EA59FAB7 at mpmail1.medprodoctors.com>
Content-Type: text/plain;	charset="iso-8859-1"

FYI . . . Another product.  I have seen this work. Bought one for all of my
trauma and critical care surgeons.

http://airstat.org/

MRM

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-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ivan Hronek
Sent: Thursday, April 03, 2008 12:17 AM
To: Trauma &amp; Critical Care mailing list; ccm-l at ccm-l.org
Subject: Cric kits now & then...

What striked me was how similar these principles still are...
this is a picture of the currently available cric kit...
http://www.statkit.com/index.cfm?fuseaction=product&itemnum=1195

Ivan Hronek MD
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Your most unhappy customers are your greatest source of learning. Bill
Gates.

Confidentiality Notice: This transmission and any attached documents may be
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or approaches perfomed in the way suggested in this note. 

----- Original Message ----
From: Ivan Hronek <ivanhronek at yahoo.com>
To: ccm-l at ccm-l.org; trauma-list at trauma.org
Sent: Wednesday, April 2, 2008 11:49:11 PM
Subject: Cric kits now & then...

Rusch QuickTrach Emergency Cricothyrotomy - 4.0mm 
currently used device 

http://www.adair.at/eng/museum/equipment/surgery/ueckermannobject01.htm
Ueckermann Cricothyrotomy Trocar (Manufacturer Unknown, Object Number 1)

This section is contributed by Ernst Zadrobilek, MD, (Vienna, Austria), and
will be regularly updated to take account of comments on this version. 

Last updated: April 28, 2002.

Ueckermann cricothyrotomy trocar with metal cricothyrotomy tube (see Figures
1 to 4) from the Private Collection of Jean-Bernard Cazalaa (Paris, France).
The manufacturer of this cricothyrotomy trocar is unknown.

Figure 1: Ueckermann cricothyrotomy trocar with metal cricothyrotomy tube.
Reproduced by courtesy of the Private Collection of Jean-Bernard Cazalaa
(Paris, France).

Figure 2: Ueckermann cricothyrotomy trocar with metal cricothyrotomy tube.
Reproduced by courtesy of the Private Collection of Jean-Bernard Cazalaa
(Paris, France).

Figure 3: Ueckermann cricothyrotomy trocar with metal cricothyrotomy tube.
Reproduced by courtesy of the Private Collection of Jean-Bernard Cazalaa
(Paris, France).

Figure 4: Ueckermann cricothyrotomy trocar with metal cricothyrotomy tube.
Reproduced by courtesy of the Private Collection of Jean-Bernard Cazalaa
(Paris, France).

Webmaster: Ernst Zadrobilek, MD. 
URL: http://www.adair.at
Email address: ernst.zadrobilek at adair.at

Ivan Hronek MD 
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Your most unhappy customers are your greatest source of learning. Bill
Gates.
Confidentiality Notice: This transmission and any attached documents may be
confidential and contain information protected by State and Federal Medical
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me at  ivanhronek at yahoo.com and delete the entire message and its
attachments. Thank you. Disclaimer: this message contains the personal views
of the author. The author will not be responsible in any way for procedures
or approaches perfomed in the way suggested in this note. 

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------------------------------

Message: 6
Date: Thu, 3 Apr 2008 07:17:15 -0700 (PDT)
From: Ivan Hronek <ivanhronek at yahoo.com>
Subject: Re: Cric kits now & then...
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Cc: Marc_Matthews at medprodoctors.com
Message-ID: <764412.18821.qm at web62301.mail.re1.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1

Can people share their experiences with cricothyrotomies with the Airstat,
Quicktrach, Melker Seldinger technique etc..I found (in the one that I did)
one has no time in a failure-to-intubate/failure-to-ventilate situation in
an anoxic patient to play with the Seldinger tech(Melker kit) and I am
thinking the one-move access that the "catheter-over-needle" techniques
allow is to be used.

Ivan Hronek MD 
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Your most unhappy customers are your greatest source of learning. Bill
Gates.

Confidentiality Notice: This transmission and any attached documents may be
confidential and contain information protected by State and Federal Medical
Privacy statutes and is legally privileged. They are intended for use only
by the addressee. If you are not the intended recipient of this
transmission, or an agent of the intended recipient, you are prohibited from
reading, disclosing, printing, saving, copying, using, or otherwise
disseminating any information contained in this transmission. If you
received this transmission in error, please accept our apologies and notify
me at  ivanhronek at yahoo.com and delete the entire message and its
attachments. Thank you. Disclaimer: this message contains the personal views
of the author. The author will not be responsible in any way for procedures
or approaches perfomed in the way suggested in this note. 

----- Original Message ----
From: Marc Matthews - MedPro MMC X <Marc_Matthews at medprodoctors.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>;
ccm-l at ccm-l.org
Sent: Thursday, April 3, 2008 6:44:28 AM
Subject: RE: Cric kits now & then...

FYI . . . Another product.  I have seen this work. Bought one for all of my
trauma and critical care surgeons.

http://airstat.org/

MRM

CONFIDENTIALITY NOTICE: This message and any of the attached documents
contain information from the Medical Professional Associates of Arizona,
(MedPro), that may be confidential and/or privileged. If you are not the
intended recipient, you may not read, copy, distribute, or use this
information, and no privilege has been waived by your inadvertent receipt.
If you received this transmission in error, please notify the sender by
reply email and then delete this message. Thank you. 
CONFIDENTIAL MATERIALS PROTECTED under ARS ' 36-445, ARS ' 36-2403 and
Federal Patient Safety and Quality Improvement Act of 2005  

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ivan Hronek
Sent: Thursday, April 03, 2008 12:17 AM
To: Trauma &amp; Critical Care mailing list; ccm-l at ccm-l.org
Subject: Cric kits now & then...

What striked me was how similar these principles still are...
this is a picture of the currently available cric kit...
http://www.statkit.com/index.cfm?fuseaction=product&itemnum=1195

Ivan Hronek MD
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Your most unhappy customers are your greatest source of learning. Bill
Gates.

Confidentiality Notice: This transmission and any attached documents may be
confidential and contain information protected by State and Federal Medical
Privacy statutes and is legally privileged. They are intended for use only
by the addressee. If you are not the intended recipient of this
transmission, or an agent of the intended recipient, you are prohibited from
reading, disclosing, printing, saving, copying, using, or otherwise
disseminating any information contained in this transmission. If you
received this transmission in error, please accept our apologies and notify
me at  ivanhronek at yahoo.com and delete the entire message and its
attachments. Thank you. Disclaimer: this message contains the personal views
of the author. The author will not be responsible in any way for procedures
or approaches perfomed in the way suggested in this note. 

----- Original Message ----
From: Ivan Hronek <ivanhronek at yahoo.com>
To: ccm-l at ccm-l.org; trauma-list at trauma.org
Sent: Wednesday, April 2, 2008 11:49:11 PM
Subject: Cric kits now & then...

Rusch QuickTrach Emergency Cricothyrotomy - 4.0mm 
currently used device 

http://www.adair.at/eng/museum/equipment/surgery/ueckermannobject01.htm
Ueckermann Cricothyrotomy Trocar (Manufacturer Unknown, Object Number 1)

This section is contributed by Ernst Zadrobilek, MD, (Vienna, Austria), and
will be regularly updated to take account of comments on this version. 

Last updated: April 28, 2002.