Rebellion21: Cut The Neck – The Bougie Assisted Cric via Andy Little, DO

In this 10-minute presentation from Rebellion in EM 2021, Dr. Andy Little, DO discusses the bougie assisted cricothyrotomy. Of the many High Acuity Low Occurence (HALO) procedures in medicine, few are as daunting as performing a bougie assisted Cric. For EM providers it is key to understand the indications, anatomy, and steps to performing this procedure on the right patients, their life may depend on it.

Andy Little, DO
Emergency Medicine
Associate Program Director
AdventHealth Orlando EM Residency Program
Orlando, FL
Twitter: @andyglittle

Presentation Objectives

1. Discuss the indications to perform a surgical cricothyrotomy
2. Discuss the anatomy crucial to performing a surgical cricothyrotomy

Presentation Outline

1. Discuss the Indications for a surgical cricothyrotomy
   1. Can’t Intubate
   2. Can’t Oxygenate
2. Discuss the Complications of performing a surgical cricothyrotomy
   1. Bleeding
   2. Posterior Laryngeal Injury
   3. Nerve Damage
3. Discuss the anatomy of the neck in relation to performing a surgical cricothyrotomy
   1. Thyroid Cartilage
   2. Cricothyroid Membrane/Ligament
   3. In adults, this is 9 to 19mm horizontally & 9 to 20mm vertically)
   4. Cricoid Cartilage
   5. Trachea
4. Discuss the materials needed to perform a surgical cricothyrotomy
   1. Bougie
   2. 11 Blade Scalpel
   3. 6.0 ET Tube
   4. Your Finger
5. Provide step by step instructions to performing a surgical cricothyrotomy

References:

1. Sorbello M et al. Front-of-Neck Access and Bougie Trapping. Anaesthesia 2018. PMID: 30132808
2. Paix BR et al. Emergency Surgical Cricothyroidotomy: 24 Successful Cases Leading to a Simple ‘Scalpel-Finger-Tube’ Method. Emerg Med Australas 2012. PMID: 22313556
3. Langvad S et al. Emergency Cricothyrotomy – A Systematic Review. Scand J Trauma Resusc Emerg Med 2013. PMID: 23725520
4. Salim Rezaie, “Bougie-Assisted Cricothyrotomy”, REBEL EM blog, February 26, 2021. Available at [Link is HERE]

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)