Life threatening, critical care emergencies requiring immediate resuscitative techniques. Sound familiar?
The dreaded Cannot Intubate, Cannot Ventilate
The dreaded Tension pneumothorax
Remarkably,similar strategies & techniques for both situations!
1. Both time critical conditions and interventions
2. Both require access to an anatomical space or lumen
3. Both can be managed with needle ( temporarily) and/or scalpel ( definitively)
4. With scalpel technique, gloved finger identification of correct anatomy is crucial to reliable performance, as demonstrated in this excellent video by Weingart and Strayer
Now contrast this to the current ANZCA teaching on emergency cricothyroidotomy as exemplified by Dr Heard’s teachings here. IN this widely taught and promoted technique to anaesthetists in Australia, the only way to identify the tracheal lumen is via the scalpel blade. The bougie is then passed along the blade to hopefully then be guided into the trachea. This is no where near as reliable as using the finger to identify the lumen and I am aware of several failed scalpel bougie attempts. I would always use the gloved finger to identify the pleural space when inserting a chest tube. I dont leave my finger in whilst passing the tube but I have used it to dilate the wound tract whilst confirming the correct space and ensuring there is nothing in the way like the left ventricle (on the left side)!
Same principle with surgical airway. Use your finger to feel the anatomy and to be sure you are in the correct space. Leaving your finger insitu whilst passing bougie is a reliable method but as long as you have digitally confirmed prior to bougie passage, you can remove your finger, pass bougie, then re-insert your finger to check the bougie is in correct space.
The teaching point is use your gloved finger for both Chest tube and Surgical airway!