Fast-forward to 40 minutes – soldier with severe maxillofacial trauma has scalpel-finger-tube cricothyroidotomy performed under IM ketamine in the back of a Blackhawk

One of the perennial debates in medicine is the choice between a surgical technique versus a needle technique for a can’t intubate/can’t ventilate situation.

The issue is discussed in this podcast by Scott Weingart and Minh Le Cong, and useful data has been produced by the NAP4 audit in the UK, as discussed in this post.

The video below shows Minh Le Cong demonstrating some approaches to needle cricothyroidotomy. What struck me was the how simple and fast the ‘minimalist’ approach is , whereby oxygenation is provided (very rapidly) by simply pressing the oxygen tubing up against the cannula hub – no furious hunting for suitable connection devices!

This is worth seeing, it looks like a very useful ‘get out of jail’ card! In the prehospital setting it could be a bridge to further attempts at laryngoscopy (in the podcast above Minh describes several occasions where this has occurred in a retrieval setting) or a more definitive surgical airway prior to transport.