Page 42 - PJ MED OPS Handbook 8th Ed

Video Laryngoscopy

• The use of a VL increases first pass success for all intubations including difficult intubations.
• VL is important during Rotary Wing operations to facilitate intubation from nonstandard po-
sitions (the patient’s side or straddling the patient).
• Practice this skill, understand the equipment, and use the correct stylet.

Cricothyroidotomy
The primary indications for a cricothyroidotomy (CRIC, surgical airway) are:
1. Maxillofacial trauma with excessive bleeding from the mouth and throat when the patient does
not tolerate the sit up and lean forward position
2. Burns, and anaphylaxis not responding to Epinephrine with associated laryngeal edema seen on
laryngoscopy, and unable to visualize the vocal cords in patients who require a definitive airway

CAUTION:
• Severe bleeding is possible with this procedure. Be prepared to suction and provide direct
pressure to control bleeding at the incision site.
• Most missed CRICs are due to incorrect anatomic localization.

PJ PEARLS:
• Find the membrane by starting at the sternal notch, going up with your finger you will go
over the first large ridge (the cricoid cartilage), the membrane lies above this.
• In lean patients, the structures can often be visualized.
• Stay in the midline. Keep 2 fingers on either side of the cartilages.
• Do not force in the airway as it will increase the likelihood of misplacement/soft tissue
tracking. If there is resistance, use a tracheal hook to further open the incision and/or
utilize a bougie and pass the tube over it. Feel for the tracheal rings with the bougie to
facilitate confirmatory placement.

Equipment:
1. Cuffed tracheostomy tube (may use 6.0–7.0 cuffed endotracheal tube if no tracheostomy tube
is available)
2. Trachea hook (if available)
3. Syringe to inflate cuff
4. Scalpel (or small knife, razor blade, or sharp surgical scissors if scalpel not available)

40 n Pararescue Medical Operations Handbook / 8th Edition