IKEA-like pics of my setup. All prepared ahead of time.! @TBayEDguy @ketaminh @emcrit @ALiEMteam pic.twitter.com/KnFqCz8zUE
— Ricaurte Solis (@SolisREMDoc) April 30, 2015
Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds
In memory of Dr John Hinds
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
Howdy Minh. Here are some comments I left with this video on YouTube…
Hello. Thanks for recording this video! I’m the dude that gave the talk at the CCTMC conference that was referenced at the beginning of the video…
Our set up is summarized in two vids on our educational site. Please check them out and give me feedback as well: http://www.tamingthesru.com//blog/acmc/needle-cricothyrotomy
With respect to the feedback you seek, I think that your set-up is very cool! If you do plan to keep a set-up on hand, I would make as much of it beforehand as possible as tie-wrapping things in the moment might be hard to do. I would also have some idea of what flow rates you plan to use for specific sized people. Most experts say to use “1 liter per minute per year of life”. There is some evidence suggesting this is OK (Frame Annals 1989, Frame Annals 1989, Baker Peds Anes 2009). There is some more recent evidence that suggests using 15 LPM might be fine for anybody (Wong Peds Anes 2013).
Regarding the idea of “pressure”, I don’t think you need much for our purpose. If your mission is rescue oxygenation, then only very low pressures are needed (this idea traces back to a studies from the 80’s). As you point out in the video, high pressure is only needed if you want to ventilate. I agree with you that this is not the primary objective. I humbly submit that the risk you take in terms of barotrauma and potential “inflation of soft tissues” is not worth it. The studies I referenced demonstrated that acid-base consequences are not that severe. I’ve actually started referring to this procedure as trans-tracheal needle oxygenation and not “jet ventilation” to reinforce this idea. Unless you are using a true-true jet ventilation device that screws into a 55 psi port, you really are doing “trans-tracheal needle oxygenation” and not “jet ventilation”.
Lastly, to address your question regarding how much pressure you are using, wall O2 systems operate at about 55 psi when they are wide wide wide open. If you screw into the wall you get that full pressure. At 15 LPM you are no where near this. What might blow your mind is that if you use a jet ventilator at full setting with at 14G angio, you are getting 1600 mL of O2 per second!! I don’t worry about pressure as I don’t go past 15 LPM (or at least that is my plan).
at 15L/min you get roughly 250ml/sec in a closed airway system. Remember most of the time its not completely closed so you lose some of that flow back up the airway via the mouth/nose. If you are keen you can have someone close the mouth and nose! I wouldnt though!