Needle Crichs

[ENG92INE]

My question is if you have someone that needs an airway bad enough that you are about to crich them, why would you do so needle wise and not just surgically crich them. It seems to me that I would not want to breath through a 14ga needle. It's like I was told in medic class, "how big of a straw would you like to breathe throug". Just curious as to the relevant point to this, I am not totally against it just a little foggy as to its point.

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Fishers FD
Fishers, IN
Local 416

[Rescue 21]

In our region we are not permitted to perform surgical cric's, only needle cric's. Only the regional critical care helicopter can do a surgical cric.

[ncfd933]

I think any medic worth their weight realizes the need for the largest and most patent airway possible, but there is a time and place for the needle cric. 1st the needle is the preferred method in children under eight years old/body size equiv. (Due to the fragile, petite and close anatomy of the anterior neck). 2nd in a case with a patient with a partial upper airway obstruction with spont respirs (with poor oxygenation), a supplimental jet of 100% just might be what the doctor ordered. This approach places the patient through significantly less trauma. In all adult cases though, the needle can be replaced by a surgical cric if it is not sufficient. Also be aware that it is acceptable to use 10 and 12 ga angios, and is acceptable to place a 2nd needle lateral to the first in the membrane to aid exhalation. Hope this helps some.

[FFCode3EMT]

I've been taught in Paramedic class to do both needle and surgical cricothyrotomy. Local protocols that I operate under allow needle as a last resort. With a needle crich, you are supposed to ventilate through a Transtracheal Jet Insufflation Device at 50 psi. Like most departments we don't have them so we were taught to use the BVM attachment from a 3.0 ETT. A needle crich is not as effective as a surgical due to the size of the airway, but any airway is better than none.


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**The preceding comments in no way represent the views of my department, its members, or associations that it may belong to.**

[crossfire]

I think the reasons needle crichs exsist is to allow at least some airway option to medics who can't perform surgicals and as a back-up. In my experience when a needle crich was used, in a shotgun blast to the throat because of anatomy problems, if did feel useless because of the amount of pressure and time needed to push oxygen through the cath, but we did have an airway. Suggestions if you wanna needle crich, determine how much cath your gonna need to keep it in place and cut the excess off, not the hub end though.