Who has done a cricothyrotomy?
Who thinks they would be comfortable doing a cric if asked? Without having a code brown first?
Though I have done a few tracheostomies (only three on live people), I’ve never done a cric on anyone. Furthermore, when it’s time to cric, we need to be ready. Unfortunately, we can’t practice on our fellow residents, cadavers are hard to come by, and industry made cric training devices are hundreds of dollars to purchase. How are we going to be ready to cric without any practice?
While there are many great videos out there showing how to perform a cric, they are usually performed on cadavers/simulators, which most of us do not have routine access to. In particular, Scott Weingart from EMCrit has a great quick n’ dirty cric video which can be found here.
While Scott’s video is awesome, there aren’t any videos on how to make your own cric trainer, so I thought it would be nice to fill that gap. Below you’ll find a video I’ve made showing the steps for making your own cric trainer.
This 2004 Anesthesiology article provides the basis for making the cric trainer. In this article, Varaday et al. compared use of a cric trainer made from a few standard operating room supplies (AKA Homemade) to expensive commercially available cric trainers. 20 anesthesia trainees practiced on the homemade device, while a second group of 20 trainees practiced on the commercial devices.
The study concluded, “trainees found the homemade model a useful substitute for practice of percutaneous techniques and teaching” and “both models were rated well, with similar scores. The homemade model is an easily assembled alternative to more expensive models”
The advantage of this cric trainer is being inexpensive, reusable and pretty realistic. I think the greatest value of this trainer will be for those who are required to teach cric’s, especially for large numbers of residents/students. One set of ventilator tubing provides enough practice “trachea” for a large number (eg. > 10-20) of cric trainers, and the remaining materials are easily accessible.
If you are an individual resident/student looking to practice your skills, you’ll just have to politely ask an anesthetist/OR staff to give you a few supplies. If you tell them the purpose of it, I doubt they’ll have much problem with it.
Having now performed a few real life tracheostomies, I think this trainer is actually very good, and approximates the real thing quite well considering how easy and inexpensive it is to make.
You’ll notice I made a few modifications from the trainer used in the article:
1 – If you only have single thickness vent tubing, reinforce the tubing and the skin with 2-3 pieces of iv tape. I find this definitely mimics reality a little better with regard to the difficulty of cutting the skin and trachea.
2 – I don’t completely cover the trainer with tape as they do in the article. I find this is not totally necessary and allows you to rotate your vent tubing more easily to make a “fresh” trachea.
3 – I have not attached a bag here to act as lungs, but if you have an O2 source and jet insufflation equipment, attaching an old bag from the anesthesia cart will add to the realism.
That’s all for today, watch for some upcoming toxicology myths that I’ll be busting over the next few weeks.
P.S. I know today’s blog was again a detour from busting up pseudoaxioms and dogma. Overall the SOCMOB blog will continue to focus on dispelling medical myths, but I’ll also be incorporating more procedure videos, rants and interesting cases as well.
Varaday SS et al. Anaesthesia. 2004 Oct;59(10):1012-5.