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Understand. Just would be interested in hearing from a surgeon or ENT
whether the infant cricoid can accommodate such an insult 



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Pediatric Emergency Specialists, P.C.
Martin Herman, M.D.,FAAP,FACEP
President
[log in to unmask]
PO box 637
Ellendale TN 38029
tel: 901 405 1407
fax: 901 405 1524
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-----Original Message-----
From: Lisa Burns [mailto:[log in to unmask]] 
Sent: Wednesday, February 06, 2008 3:37 PM
To: Martin Herman
Subject: RE: Needle cric

Not per the manufacturer, it does come in an adult size, I think a 6.0
(not sure the exact size). The ID is equivalent to the ID of an ET tube
so term infants on up.

Lisa (Burns) Davidson,RN,BSN,CCRN

John C. Lincoln Deer Valley
Clinical Educator
Pediatric Services
ph: 623-879-5483
cell: 480-381-9934
email: [log in to unmask]
 
"What you leave behind is not what is engraved in stone monuments, but
what is woven into the lives of others."  Pericles
 
 

-----Original Message-----
From: Martin Herman [mailto:[log in to unmask]] 
Sent: Wednesday, February 06, 2008 12:34 PM
To: Lisa Burns
Subject: RE: Needle cric

Any age restriction on its use?


------------------------------------
Pediatric Emergency Specialists, P.C.
Martin Herman, M.D.,FAAP,FACEP
President
[log in to unmask]
PO box 637
Ellendale TN 38029
tel: 901 405 1407
fax: 901 405 1524
mobile: 901 219 9202 
------------------------------------

-----Original Message-----
From: Lisa Burns [mailto:[log in to unmask]] 
Sent: Wednesday, February 06, 2008 1:26 PM
To: Martin Herman
Subject: RE: Needle cric

We use the Melker Emergency Cricothyrotomy kit in our pediatric ED,
which has an ID of 3.5 mm, works well in lieu of needle or surgical
cricothyrotomy.

Lisa (Burns) Davidson,RN,BSN,CCRN

John C. Lincoln Deer Valley
Clinical Educator
Pediatric Services
ph: 623-879-5483
cell: 480-381-9934
email: [log in to unmask]
 
"What you leave behind is not what is engraved in stone monuments, but
what is woven into the lives of others."  Pericles
 
 

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Martin Herman
Sent: Wednesday, February 06, 2008 10:52 AM
To: [log in to unmask]
Subject: Re: Needle cric

Has anyone done a needle cricothyrotomy on anyone under 8? 

I believe that is the cut off age for this technique. So for a pt under
8 ,
what are your options? 

We have tried to learn and used a lighted stylette..
We are looking into getting a video assist devise like the
glide-o-scope. 

A difficult airway in a young child poses significant challenges. 

Marty

------------------------------------
Pediatric Emergency Specialists, P.C.
Martin Herman, M.D.,FAAP,FACEP
President
[log in to unmask]
PO box 637
Ellendale TN 38029
tel: 901 405 1407
fax: 901 405 1524
mobile: 901 219 9202 
------------------------------------
-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Doc Holiday
Sent: Wednesday, February 06, 2008 4:59 AM
To: [log in to unmask]
Subject: Re: Needle cric

From: Erik Schobitz 
> Needle cric was performed with an 18 guage angiocath...briefly able to
oxygenate, but lost the needle cric while trying to re-start her heart -
she
unfortunately died.

--> My personal experience on this issue...
Please forgive the style. I am autistic and write things a bit more
"black &
white" than perhaps you are used to...

Based upon work in a "Level 1 Trauma Centre" equivalent in the UK and
experience since the late 80s, including various environments and
pre-hospital work. Also teach on ATLS, etc and thus try to keep up to
date...

- Needle cric has NO advantages over "proper" cric
- As you have already experienced, it does have a number of
disadvantages...

- Main causes for failure with needles:
   - It often produces a "core biopsy" of skin & tissue, which blocks
the
needle and thus fails. This may be overcome by having 0.5ml of saline in
a
syringe to flush it
   - It often blocks LATER by blood or secretions
   - Over-needle caths are flimsy and WILL kink
   - ALL THESE BLOCKAGES, at any stage, are OFTEN missed and go
unnoticed!!!
   - Many needles, designed to CUT through skin, have a long, sharp
bevel,
dangerous for the posterior internal aspects of the younger smaller
tracheas...
   - It only provides oxygenation, not allowing CO2 to be removed
   - High pressure required to oxygenate - with its dangers
   - Tough to monitor: usually no chest rise and no CO2 monitoring...
   - Difficult to secure (especially without kinking)... As in the case
mentioned...
- I will not bore you with how a needle has no cuff, like the proper
cric
kits do...

- There are a number of suitable task-specific cric kits, rather than
"adapting" a needle or angiocath for a task they are not designed for -
this
temporising measure was invented over 25 years ago, BEFORE all the
modern
kits and training became available. We should no longer be using 2nd
best
- ATLS still teaches both methods. The needle version being supposed to
"buy
time". There is the understandable (but mistaken) assumption, because we
are
still teaching it, that there must be some use for it. YES - if you do
not
possess the proper equipment (e.g. you work in some poor 3rd world
environment), then you can think needle cric
- Hope you're sitting down, but a lot of military and other pre-hospital
teaching is that definitive cric is even the choice BEFORE oral
intubation,
ESPCIALLY for non-experts in intubation. Think about it - intubation is
a
skill so much time is spent learning and practising and worrying about
the
difficulties and failures of. But finding the cric membrance and getting
something through it is not as tough as finding the cords! There is no
frequent problem with "visualisation" or secretions or bleeding in the
way... No problem with positioning in trauma patients. MUCH MUCH MUCH
easier
to teach new paramedics to do well than is intubation!

> Ugly situation all the way around but if you get to that point I
belive
your likelihood of survival is pretty low no matter what you do.

--> "Likelihood of survival"?
That's epidemiology! NOT emergency medicine...
You have a patient. You do your best. The statistics will take care of
themselves.
Which means that, if you THINK you need a DEFINITIVE AIRWAY, you might
as
well put one in. Then, at least, even in your case, if the patient does
unfortunately die, it's DEFINITELY NOT because some second-best device
(needle cric) has failed.
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