"emergency cricothyrotomy"

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>From what I'm reading, the review is over: you were having a far better
day than your colleague.  Nice job.

Is there something else you wanted?

Pret Bjorn, RN
Bangor, ME USA


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of LanceO Oosthuizen
Sent: Sunday, January 07, 2007 1:46 PM
To: traumalist
Subject: "emergency cricothyrotomy"

Hi All

I am an ALS paramedic from SA just south of Johannesburg. Just recently
I received a call of a male patient 29 who came off a quad bike in a
remote area just out side the town where I live. The mechanism was that
he veered off the road and hit a wire fence and well cemented pole next
to the road. He was not wearing a helmet.

O/A I found the patient lying supine about 4 m from the point of impact.
The patients vitals were as follows:

GCS = 12/15
BP = 110/45
Pulse = 64 bpm no significant pathology on the ECG tracing
HGT = 5.4 mmol/l
SpO2 = 94% with 60 % re-breather.

H-T revealed that the patient has no neurological function from the
shoulders down, even to deep pain stimulation. there were areas of
mottling and the patient had parasthaesia over the left anterior
abdominal area. There were abrasions to the hands and the left flank.
The patient had an ethanol smell on the breath and bystanders mentioned
that he had been drinking.

My immediate action was to control c-spine manually and fully immobilize
the patient, insert bilateral large bore I.V. lines. We were about 100
km from the nearest facility with a neurosurgeon. My reaction was to
task the medical helicopter to cas-evac the patient to the hospital.

When the Chopper arrived the attending Doctor assessed the patient and
elected to RSI the patient, due to the distance (20 min flight) and
patient was intoxicated. After administering etomidate and sux  the
Doctor then proceeded the intubation, first attempt was unsuccessful the
patient was then pre-oxygenated to a sats of 99%. Second and third
attempt was also unsuccessful, but managing to pre-oxygenate the patient
after each failed attempt. He mentioned that the patient has a difficult
air-way and was difficult to visualize the cords.

After the third failed attempt the Doctor then elected for an "emergency
cric" on the patient. I requested one more attempt by my self and he
refused me to have an attempt, I made it known to him that I thought to
go for an cric was a bit of a harsh move now. None the less he still
proceeded. Several attempts were made at the cric, but with no success,
I then stood in and lost my temper a bit and told the Doctor to stand
aside and that I would take over now and attempt to intubate the patient
orally. I managed to intubate the patient on the first attempt
visualizing the cords with ease. I would score the patients air way a 2
for difficulty at the most as he did have a rather large tongue and the
epiglottis was also larger than usual.

I am just requesting the view of any one on this call, on the 24th
January 2007 I will be attending a M&M on this matter.

Regards,

Lance
Critical Care Assistant Paramedic South Africa.

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