Some of you need to hear this…. Never ever “improvise” a cric. Just because you saw it in a movie doesn’t mean it should be done. Furthermore, this video is to refresh the memory of trained responders and give non-medical personnel an insight into what the procedure entails. That’s it. Full stop. Don’t do this unless your scope of practice, protocols, state law align to allow you to do this.

Been a combat medic for about 3 years now, I have always found it hilarious how they train us on all of these interventions and combat skills, then throw us into a clinic as a glorified nurse for years on end

Hey guys I got this. I saw a KZfaq video on it once

Pig throats work really well for practice. We use those on our USAR team for training. Go to your local butcher get pig throats all the way to the lungs . Then you can put a plastic bag around the lungs and practice needle decompression too .

I’m an ER resident physician and work as a tactical medic as well. I’d add that unidentifiable anatomy isn’t always a contraindication. Severe angioedema, Lidwigs, some facial or neck trauma can all cause scenarios of can’t Intubate/can’t ventilate and necessitate a cric.

I want to thank you so much for this video. I tried this out on my cat yesterday, and it was a success! I really appreciate the information!! Keep it up!

Been loving the medical videos as a break from gear reviews, as an EMT who wants to become a medic and LOVES learning new thing, these honestly are amazing videos

I want to be a tactical medic at the hungarian special forces. AND THIS MEANS A LOT TO ME SO THANK YOU .

This is the best tutorial I’ve seen on this topic. I’m a critical care helicopter paramedic with 30 years in the field I’ve been involved in 3 (all successful) of these procedures in the field. Great job @prepmedic 🏆

i'm a student paramedic in the UK and found this video really helpful, thank you for putting in the effort to make this video happen :)

Excellent video. I have been the medical director for 3 helicopter systems, Including the 927th PJ unit. As a combat medice with the 25th Inf. Vietnam, I took care of a lot of GSW victims to the the head and neck. Always have a GSW victim sitting up and tell them what you are going to do. Find the landmarks, Make your first incision vertical. Make your cut through the cricoid membrane horizontal. Use a trach hook if you have one to lift up on the trachea for insertion of an ET tube (Cut back like in the video). Put a Bougie into the trachea and then railroad the ET tube over it. Use Tape the control the ET tube. If it is an alert trauma victim, let them decide how to breath. NO PARALYTICS, unless you cannot control the victim. Use IV Narcotics or Ketamine for analgesia. Col (Ret- Not) Glenn Ekblad, DO, MPH, MSN, FACEP. Anesthesiologist from U OF M. So What. Points. Control the airway first. Then give IV meds. Thank you to all of my "HIGH SPEED, LOW DRAG" Medics. GSE out

Respiratory Therapist here. Well done!

I just found your channel, I’m a former active duty Marine thank you for these videos, as a veteran it’s comforting to have a resource to refresh on this type of training.

Very informative. Not an EMT, etc but fascinated by the med world and VERY thankful for those professionals (Such as YOURSELF) and techs in the field! Thanks..really appreciated

This reminds me a lot of Scott Weingart’s scalpel, finger, bougie presentation on the EMCrit podcast. This is a very well done video on the topic. Nice work.

I'm a former combat medic, I served in Afghanistan. While on patrol, i conducted a surgical airway under heavy fire. Casualty was then placed in the back of a moving tank as the LZ was too hot. The rear door remained completely open due to the stretcher being too long for the rear to close. As such, the door broke and exposed me and the casualty to enemy fire. The airway worked extremely well but a suction device was definitely a must, just in terms of helping you initially clear the airway prior and after the surgical airway. The velcro strap that secures it to the patient's neck isn't great in all conditions.

**Murphy's Eye, no Islets of Langerhans** my mind was stuck on cellular anatomy for some reason.

Best video so far! I’ve been waiting for this one! One of the coolest things medics can do

Hi. I'm Hospitalist PA in Washington, D.C. I subscribed. What a WONDERFUL channel. You're a good teacher.👋🏾👨🏾‍⚕️

Very interesting seeing the procedure done on a practice piece. I'm a pediatric trach/vent nursein homecare obviously as an LPN we can't do the procedure but we do have orders from the doctor as to how often to change the tube and emergency orders for when it comes out. So I put in quite a few trach tubes also had two of my patients pull their tube out which unfortunately results in respiratory arrest. Luckily we have orders allowing us to stabilize and monitor in the home and if no improvement we send them to the hospital (I've been lucky both times the patient ended up fine and it was resolved in a minute). Thank you for the great video.

Great video. One point - the bougie typically does not stop ("hold up") at the carina, but typically it keeps going into the right mainstem bronchus and holdup happens in some large airway on the right. The carina is very close to the cricothyroid membrane -- so the bougie will go well beyond it, and you have to be careful about only putting in the ETT (if used rather than trach) only so the balloon barely disappears.

The way I learned it at the TECC course was quite similiar to the first way in the video. But instead of using the finger we used a nose speculum to blunt dissect. The service I'm currently working for provides regular et tubes for the procedure. But hontestly being an EMT* I highly doubt, that I will ever perform it. Anyhow great very informative video! Grettings from Europe! *German/Bavarian equivalent "Rettungssanitäter", at least 520hrs of training

Great job! Im an ortho PA now and a combat airborn medic veteran not combat veteran. The way things are going I want to be ready for as many problems as possible. Thank you for the refresher.

Thanks for a great video! It''s really important to train this procedure regularly since you will probably only do it maybe once or twice in your career. I can only think of one thing to add (although it doesn't really apply to your model): Remember to extend the patients neck all the way back to better expose the structures before cutting.

Great video Sam, I want to be a Paramedic so your videos are very helpful!

Very well done video. Reinforced my previous training. Thanks!

Hope you guys realize the value you are providing. And motivation.

Thank you for this great video, Im a critical care PA and found this helpful

Top job with the video! I too have been taught your HEMS technique, with the first option for those that you can’t palpate so easily. Not a skill I’ve had to use yet so this will be handy to refresh periodically.

When I was taught we used a nasal speculum. Which we used like a tracheal hook but also as a spreader. Worked well also.

You channel is saving lives my man. Thank you.

Good video, have done a few of these but this is a good refresher. I was trained on method #2, and have always done them that way.

Also I would check the balloon for patency before beginning the procedure. Yes it's rare for a balloon to have a defect but it has happened to me a couple of times in my career, more often with Foley catheters which is a completely different subject.

Have you ever heard of using an IV drip chamber? After the procedure your BVM fits perfectly on it.

Was a combat medic back in the 70's and was taught that second method only (your helicopter method). Thanks for the great info.

The eyelet on the end of an ETT is called the Murphy Eye, named after a Dr Murphy who designed the ideal endotracheal tube. Islets of Langerhans are endocrine cells found in the pancreas. Thank you for the video, I feel a lot more prepared for my upcoming wet lab class!

Having been a paramedic with a bit of experience, we had Nu Trake Kits in the airway bag, along with catheters to do peds cric's, Introducer guide wires to perform retrograde intubations when the anatomy is disfigured from trauma. In 8 years on the street I used the Nu Trake Kits 2X. Back then they were expensive. Needle crics work well a large bore IV catheter using them with small peds ETT uncuffed you take the bvm attachment off the ETT and then it fits right into a large bore iv catheter hub. Or as pointed out the drip chamber from an IV set up. The first time using a Nu Trake I hesitated a bit too much, and it was bloody mess. The 2nd time was better. But, lab work has changed over the years providing practice. The thing about skills is that they have to become a "thoughtless" reaction to a given circumstance. Because if the patient is not breathing well you are toasting their brain! If you ever want entertainment.....work in a large teaching hospital with residents and interns scratching their "SIX".... Especially around the time each school year starts! Not demeaning Flight Medics or Flight Nurses, but they are not God's. Yes, many have an expanded scope of practice as granted by their medical director. But, if you study patient treatment protocols there are some very aggressive protocols for ground and flight teams alike. And, there are some restrictive EMS systems, too. EMS is wonderful world.

Thanks again Sam and particularly for mentioning the options... regards.

Idk why you showed up on my recommended but I’m glad you did your awesome man

This has helped me understand soo.. much more. If I had to do, I won't have your equipment, but the beautiful principles you showed, could help me save a life. Thanks for saying "infection can be dealt with later", that gives me more confidence. I've got deep vein thrombosis and canned oxygen helped me this past Sunday, with heart clots. I know what oxygen deprivation feels like and I need to know how to help others. Thank you very much for teaching us

I’ve done 4, all successful, without significant hypoxia (upper 60’s in lowest one). The biggest thing is to do it as soon as you realize you can’t ventilate or intubate. Don’t wait till you have a dead patient. I’m an ER doc. There is no ideal circumstance, and no one gets enough experience. You are the most experienced person. There will be a lot of blood. Your hands will shake like crazy after. I use a bougie and a 6.0 ETT.

Great video. We were taught the second technique with the option of inserting a small laryngoscope into the hole to open it and for illumination. We also cut the ETT but do it at a slight angle to make it easier to replace the ETT adapter.

Thanks! Definitely going to try that on my colleagues tomorrow at work.

George Clooney taught me how to do this on ER in the 90s. Thanks George! Still haven't needed to try it yet though.

I almost had to do this to my wife with a straw and a steak knife. Thankfully, the need was averted, but this video confirms I would have done a pretty good job despite having ZERO prior training. Great video. Thank you for posting it.👍🏻

**my face when struggling to breathe as a man comes to my aid only to realize the horror in his words when says "I'll help, i saw this on youtube!"** 💀💀💀

I did this on a cadaver and inserted a chest tube after doing advanced EMT training in the Army. Advanced Airway Tx is not easy. Like any medical skill some have a talent for some while others require practice.

Thankyou brother for all the refreshing info been a while since I did all this.

If you aren't trained and certified, any invasive medical procedure puts YOU at risk of a huge law suit! I was a certified paramedic, but I'm now retired, my certification has expired. So for me to attempt anything like this would be ludicrous!

Thank you for the demonstration. I'm always fascinated by surgical procedures and this video definitely helped me to understand the procedure and importance of this life saving skill. Prep medic, where can I buy these training tools that you've used?

Dude, you’re a hero! Mad respect 🫡

Did my first one on a motorcycle wreck the other night. Definitely have some guaze ready as it's going to bleed some. I inserted the bougie prior to pulling out the blade and everything else went fine. It's definitely scarier to think about than when you do it. Good video though!❤

I'm learning to be a surgeon entirely by watching KZfaq videos!

Nice job. Was a RN/Medic on a helicopter for 28 years. Probably only did a dozen my whole career thank God. One thing I will add is make the cut big enough. My first few I was worried about making a nice tidy clean small incision. Makes your life far more complicated especially when you got someone with a large or fat neck or a huge amount of swelling. Think of the situation you are in. They will have plenty of time back at the trauma center to sew that neck up if the patient survives. OPEN that skin and tissue up so you can cut that membrane. I would "pop" the scalpel through the membrane. While the scalpel was still through the membrane I would insert my Kelly clamp in the hole and then take the scalpel out. I would use the Kelly's to open the membrane significantly. I would then slide my finger along the Kelly and into the hole. Don't take your finger out of the hole. I have used ETT before but even cut they are a pain in the arse to use and secure. I always found a #7 shiley trach worked the best. I never needed a bougie as the Shileys have an obturator that will allow you to slide the entire Shiley right in. Bury it and then pull the Ob out. Slap on your End tidal and bag and you should be good. The other part I loved about the Shiley is the head strap that comes with it. No matter how much blood, puke or bone you can always get that strap around their neck and velcro and clips hold awesome. Last tidbit I will add is I landed on a scene once where a crich was already performed and they were having a heck of a bagging the patient. What had happened was the person had such a fat neck that they lost the hole and put the tube into the subQ tissue and were trying to bag into the tissue. Its really easy to lose your way on the huge necks. I just opened the cut much bigger and then was able to find their original puncture which was good and feed the Shiley into it. Good luck and stay safe out there.

I fw this your doing a good thing giving us citizens that don't have immediate access to ems at least a chance Incase it is a critical moment and there's no time left

youtube has been pushing this video on me for a solid 6 months, yes ive done some EMS and emergency service work but can i legally and will ever do this no. bot i give in youtube i shall get a beer and sit down and watch and like.

You said you inserted the bougie tip into the islets of langerhans.... The Pancreas? Guessing you mean the Murphy Eye? ;) Edit: Ooops should have read the comments lol

ive heard about these procedures being done with a ballpoint pen, seems highly unlikely

Very horrifying but I can appreciate the extensive and ludicrous training that goes into creating these types of procedures. So many people have been saved by these things.

Great presentation and thank you

I wish you would use layman terms to explain a down, and dirty how to save your buddy when time is of the essence, and for us that don't have any medical training. Please give the reason(s) we would need to do this.

Step 1: Don't. Step 2: No, really. Don't. Step 3: This is not a movie. Just don't. Step 4: If you really must, let it somebody do, who has proper training (e.g. not YT university).

I'm a stoner from my house and I want you to know this video blew my mind, man.

Just awesome, thx! You articulate this extremely well bro.

I've done a few of these but now I'm old and retired. This proceedure is basically the same as it was back in the 70's.

Thank you very very much for making this video I just learned something very valuable so thank you very much for sharing I've always wondered how this procedure would be done if need be I am so glad that I watched this video and I subscribed like and share but take care and God bless

im going to northern london in a week this will help very much thank you

Excellent visuals. Thx. Very much. I would pre^thread a trach tie on one side or actually preposition the tie under neck and reconnect afterwards. This is well done. Cant imagine how much blood would be involved. I once reviewed a video from John Hopkins years ago. About sterility of bedside tracheotomy. It was a great video. Thx.

Great video Sam!

i pray to god i am never ever in that situation but your video was very informative and honestly if i was in that situation although i would be stressed to the max i feel i now have a better understanding of what to do to buy me critical time until i could get professional help and give me a fighting chance for a good outcome - thank you soooo very much

Excellent review!

17:22 - I’m so glad that you clarified the Islets of Langerhans/Murphy’s Eye mixup in the description 😂 I’m a registered nurse (not trained to perform this procedure!) and was wondering what these fancy little pancreatic cells had to do with an ET tube 😂 I didn’t know the anatomy of an ET tube, but I knew that didn’t sound quite right! 😅

Excellent information!

Absolutely Totally Awesome Video Thank you so much for this video.

I do not know anything about medical procedure and I'm watching it.

good vid. We learned blind digital intubation under fire...complete dark, bullets flying over head. It was intense.

I remember an episode on MASH where Radar was doing the 2nd version of this procedure (single cut side to side) under direction from Hawkeye via 2 way radio and Radar used a pocket knife for the incision and a pen tube to provide the airway.

Amazing point 👍

I just want to suggest something as a patient with severe obstructive sleep apnea...Ive had a Montgomery tube Stoma Stent since 2004 to treat same...I had gotten a pseudomonas infection and would much rather see a clean hook being used than a finger...I totally get in a combat environment, you may have seconds to complete the procedure in which case get it done...Having also been a US Marine, I highly understand those situations. Just wanted to give some first hand food for thought...Outstanding job on this video

Very good ! Congratulations.

Excellent video

Can't wait to try this on my friends!

GREAT JOB!

Works very well with my Dog, thank you KZfaq doctor 😊

Very informative, thanks.

Gonna give it a go right now thanks!

This guy is so badass! Thank you Sir.

That's very helpful. Thanks pal.

I must say after watching your very informative video, using a tracheal hook is a bit of a waste of time. Interesting and very helpful. Lastly, I prefer your helo technique much better. Thanks Sam!!👍👍😁🇺🇸

I am 32 years of age in Victoria Australia . I would love to hear from someone anyone who has had this and how are you now? I’m traumatised mentally . I woke up 14 days ago and remember trying to talk they said Stacey you have a tube down your mouth you can’t talk we are about to take it out. Anyway I than heard what had happened and why I was in a coma for 2 days. Ambulance arrived they couldn’t establish a airway . Saturation drop 6 percent in 90 seconds. They performed a emergency cricothyroid procedure. Than apparently when I got to ed it was transferred to a tracheostomy. All I remember the 10 days I was in hosptial is how lucky ambulance saved my life. I know I should be appreciative but I feel sick to the gut of the paramedic assigned to me that day maybe hadn’t of done one before? On my discharge letter it States I had a collapsed lung and Subcutaneous emphysema.

Very well instructed...was a sports medicine staff member as a student in college, worked the football practice field. Instructed by team physician during seminar. Much clearer now...thanks!

Great video keep them coming

Congratulations, from Brazil!!! 👏👏👏👏👏

this is fascinating

GREAT LESSON THANK YOU

Thank you so much sam you're incredible l I'm following you from Arabic country ♥️

You are truly awesome.

Can't wait to try this

No one: Me: why am I listening to this to fall asleep?! No idea. You have a very reassuring voice!

Great video