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Wait a minute how did that happen…

*** This post contains images some may find graphic or disturbing – stop reading now if you are sensitive to graphic photos of surgical procedures***

Two weeks… Really???

I looked back at the date of my last post to find it had been two weeks already. It hasn’t seemed that long in the real world. There are so many things that have come up in class that I want to share… Illicit drugs, Excited delirium, Cocaethalene, Capnography, intubation… its been a busy two weeks.Which is probably why they flew by without me even realizing it.

We have the upcoming week off – although for me it is full of rotations through clinical sites – maybe I can catch up on some of the topics I am eager to write about in that time frame.

I have been outed as well… One of my classmates found the blog on FB and started reading it and was like WOW this is all of the stuff we are talking about in class, couple that with the info in the about me and stuff I’ve shared with classmates in conversations and my time in the Marines turned out to be what gave me away. While on the one hand it’s cool to get some recognition for what I write on here, it makes it a little more awkward as well… there is something to be said for writing anonymously – it takes away the pressures of having to be ultra careful about what you say and being able to express yourself without reservation. I don’t think it will affect the blog much as I only write about those topics I really believe in and express opinions that I would not be ashamed to defend.  I am conscious of it though so I suppose if there is any blow by effect it’ll reveal itself down the road.

Last night we did a cric lab where we did both a needle cricothyrotomy and surgical cricothrotomy on sheep tracheas… Pics posted below.

The service we are doing our rides with has a waiver for surgical crics, so we are expected be able to do those as well as the standard needle crics.

Here is the set up we arrived to

We each got a chuck, a 14g angio, a scapel, and a 6.5 ett, along with a syringe to start with

Add one fresh sheep trachea (still cold from the fridge)

Trying to hold the epiglottis up and open the trachea enough to give you a view of the cords and the glottic opening

The first step was to perform a needle cricothyrotomy - insert the catheter at a 45 degree angle in a caudad direction through the cricothyroid membrane

If your question is the same as mine was at this point – ok we are in the airway but how the hell do we ventilate this patient ? Attach a 3 cc syringe to the angio and the adapter from a 7.0 ETT will fit down into the syringe allowing you to hook a BVM to the catheter. Other methods were demonstrated for us as well… but that was my personal favorite.

Next we moved onto surgical cricothyrotomy

We started by cutting our tubes down to just above the tube that inflates the cuff (in reality we would have used a full size tube and cut it after getting the patinet ventilated)

Then we made a surgical opening in the cricothyroid membrane

Beginning the incision into the cricothyroid membrane

From my blurry hand and scapel you would think I was cutting at light speed... damn cell phone camera

Passing the tube through the surgical incision

Successful insertion of the ETT through the surgical opening we created. This "patient" is ready for ventilation now

It was rather interesting to actually perform these skills on something that was close to the real thing, hopefully should I ever need to use these skills this lab will have given me enough confidence in the skills to perform them without unnecessary hesitation.

 

 

Posted by on November 17, 2011 in Airway Managemnt, Paramedic School

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