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Thu Apr 3 19:07:21 BST 2008

This goes back to preferences and principles
The principle (standard of care) is that the airway needs to be opened below the cords
The preference depends on: Conditions. situation, skill and knowledge of the operator and, equipment available
the conditions - pt very sick and needs immediate airway opened
the situation - patient and operator are near each other and there is no interference (fire, toxic fumes, etc)
the skill and experience is what the operator knows how to best and has the most experience
the equipment is knife, tube, hemostats etc

Therefore it seems that the skill of the operator is what he/she can do the best and the quickest. This will vary from operator to operator. The most experienced person with the skill on the scene should be in change and direct (or at least be in control of) the procedure

The bottom line is how the operator (who is on the scene) can do it best not how the potential operator on the internet can do it best.

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Ivan Hronek
Sent: Wed 4/2/2008 1:40 PM
To: Trauma &amp; Critical Care mailing list
Subject: Cricothyrotomy vs.tracheostomy ?

Jose, that's the very isue: most people have more experience with trachs - obviously !
So they go and do a trach: however, as Eric says, this takes longer and in an emergency in an anoxic patient
the few minutes can make a big difference !

That's exactly the opposite what I was trying to say: it should NOT depend on whichever you have more experience with but rather on the need of the particular patient: a cric should be selected in an emergency if it is technically feasible of course, as Tchaka points out. It is a Pyrrhic victory to have a good permanent airway in a brain-dead person.

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: josemaya01 <josemaya01 at prodigy.net.mx>
To: trauma-list <trauma-list at trauma.org>
Sent: Wednesday, April 2, 2008 11:02:13 AM
Subject: Ref:Cricothyrotomy vs.tracheostomy ?

Whichever you feel more comfortable with and have more experience.
José Mayagoitia, M.D.

De : "Ivan Hronek" ivanhronek at yahoo.com
Para : "Trauma &amp; Critical Care mailing list" trauma-list at trauma.org
Copia :
Fecha : Tue, 1 Apr 2008 06:55:25 -0700 (PDT)
Asunto : Cricothyrotomy vs.tracheostomy ?

> Cricothyrotomy vs. tracheostomy in a failure to intubate/failure to ventilate anoxic patient:
> It appears some surgeons are more comfortable to go for a tracheostomy as this is what they do more often.
> Cricothyrotomy is expected to be a much quicker way to obtain an airway.
>
> What are your views and experiences on this dilemma ?
>
>
> 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: "Sise, Mike MD"
> To: trauma-list at trauma.org
> Sent: Tuesday, April 1, 2008 6:29:27 AM
> Subject: RE: trauma-list Digest, Vol 58, Issue 1
>
> A question for the trauma.org-istas:
>
> You've completed a brilliantly conceived and daring executed trauma laparotomy in an obese (5 ft 10 in - 250 lbs) hypotensive patient following a motor vehicle crash who required significant resuscitative efforts (1:1 transfusions with a spritzer of normal saline) and is now a bit cold 95F (35C) and you packed the liver which was mildly wet and you placed a drain over a contused by not lacerated mid portion of the pancreas. The patent is hemodynamically stable and you plan a return in 24 to 48 hours depending on his status. There are not bowel anastamoses to perform. There are not other associated injuries.
>
> How to you do your damage control closure: specific details please - do you do anything to prevent recession of the abdominal wall - i.e., sutures approximating the edges or other measures. What is you ventilation and sedation strategy with the open, damage controlled abdomen. Please add any other thoughts you find valuable.
>
> This is an area of much creativity (variation) and we need to share our thoughts.
>
> Mike Sise
> San Diego, CA
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
> Sent: Tue 4/1/2008 4:00 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 58, Issue 1
>
>
>
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Cricothyrotomy vs.tracheostomy ?