[Dick]

I'm working on the assumption that it is absolutely necessary, and that having to do one isn't all that unlikely.

I know several people who have severe allergies that result in anaphylaxsis.

Someone going into an anaphylactic shock in response to a bee sting or a peanut butter contaminated sandwich is a very real possibility. A common symptom is for the tissues in the throat to swell and block the passage of air. My understanding is that if you can’t respirate the patient you have about 4 minutes until the patient will likely die of asphyxiation, leaving you with only one option...a tracheoscopy.

At least I don’t think i can get Epinephrine for my first aid kit.

[Celticwarrior]

Ask your doc for an Epi-pen. It's a pretty common item, not restricted, and should be something any physician would be happy to let you have a scrip for. He should even be able to give you simple instructions on it's use if you ask.

As for an anaphylactic reaction, yes it is true that it could cause a person's throat to close up and choke them, and it is possible that a trach/crich is the only solution to save a life. However, even in professional cases of doctors or parameds doing a trach, things can go wrong, and many lawsuits are filed every year for such efforts. Now, if you absolutely need to learn to do an emergency cricothyroidotomy, here are directions for both needle and surgical. I hope that you never, ever need to use them, and I would STRONGLY suggest that you call 911 and have them patch you in with an emergency room doctor to talk you through ANY procedure like this personally.

Cricothyroidotomy - needle and surgical
Cricothyroidotomy
Cricothyroidotomy - Medical Procedures - Medstudents

[Rayzerm]

Originally Posted by Celticwarrior

Ask your doc for an Epi-pen. It's a pretty common item, not restricted, and should be something any physician would be happy to let you have a scrip for. He should even be able to give you simple instructions on it's use if you ask.

As for an anaphylactic reaction, yes it is true that it could cause a person's throat to close up and choke them, and it is possible that a trach/crich is the only solution to save a life. However, even in professional cases of doctors or parameds doing a trach, things can go wrong, and many lawsuits are filed every year for such efforts. Now, if you absolutely need to learn to do an emergency cricothyroidotomy, here are directions for both needle and surgical. I hope that you never, ever need to use them, and I would STRONGLY suggest that you call 911 and have them patch you in with an emergency room doctor to talk you through ANY procedure like this personally.

Cricothyroidotomy - needle and surgical
Cricothyroidotomy
Cricothyroidotomy - Medical Procedures - Medstudents

Like CW says, doing this sort of stuff is really playing with fire. The margin for error is soo small and if you are doing this, your hands WILL be shaking like you wouldn't believe. If you are messing around in the throat structure of someone, shaking hands are not what you want.

I've worked though this sort of scenario before. If the choice is "do something and risk the person's life" OR "do nothing and watch them die for certain", I will act....but only if there is no other option whatsoever.

I've been in the situation where hard calls had to be made. It worked out, but could easily have gone the other way.

Please
Please
Please

Think very carefully before you undertake any such procedures....

[Dick]

What about intubation? I always carry rubber surgical tubing. Would you consider that a preferred option?

Just for clarification:
• I know they are having an anaphylactic reaction
• I checked for an obstruction anyway
• I tried artificial respiration...unsuccessfully
• I do not have access to professional advice

[Rayzerm]

Originally Posted by Dick

What about intubation? I always carry rubber surgical tubing. Would you consider that a preferred option?

Just for clarification:
• I know they are having an anaphylactic reaction
• I checked for an obstruction anyway
• I tried artificial respiration...unsuccessfully
• I do not have access to professional advice

If the throat is so constricted, lets be honest, it is unlikely you will be able to intubate successfully.

If I was in your position, and there was no hope of help and the casualty was in danger of death, then yes, I would go ahead and cut....

Intubation would always be a preferable option to surgical solutions.

I don't mean to get on your case Dick. Sorry if it came over that way. You seem to know what you are talking about and have carefully thought about it. Most people see ER and assume it is easy and straight forward. I guess my intention is to make anyone who is reading this thread think before they Act.
You have thought already. Please accept my apologies.....

[Celticwarrior]

Tubing for insertion into the cut? Any small tubular hollow item will do. Make sure that it is taped securely into place so that it is not aspirated into the throat through the opening. Intubation as in down the throat would require an intubation guide and specific tubing for that purpose. You can buy these kits Intubation Kit relatively cheaply. However, once again, if you don't have specific training on this, don't do it. You could cause tears in the esophagus that could be fatal or damage someone beyond a surgeon's capability to fix. GET PROFESSIONAL TRAINING. If you want to act like a medic, either in wilderness conditions or in a survival situation, then it is your responsibility to those in your care to have received all the possible training you could get on these emergency procedures. They are too complex to trust into just written diagrams and short articles on the subject. It takes hands-on training and time in the field doing the work. Getting EMT training is a year or two process, and then clinical work on ride-alongs will get your hands 'dirty' doing the actual procedures. It is time well spent if you anticipate being the only caregiver or responder in an emergency.

[Dick]

Originally Posted by Rayzerm

I don't mean to get on your case Dick. Sorry if it came over that way...Please accept my apologies.....

No worries, mate. Your caution is warranted and no, it didn't come across as a castigation.

I’ve spent countless hours working in the woods. There was usually only two of us and we were hours from any cell phone coverage (hell, I don’t have a cell phone anyway!), and possibly hours from our truck radio. Even with radio access I’m pretty much on my own, although trying to contact a doctor does make a lot of sense.

Sometimes I’d have 30 tree planters out there with me, and I’d have no knowledge of allergies etc.

By my reckoning the likely scenarios I could expect to deal with were puncture wounds from falling, or from a critter attack; fractures etc. from ATV / snowmachine roll over; eye punctures; dehydration; hypothermia; frost bite; and anaphylaxis.

True to my nature i wanted to be prepared, at the very least, for the most likely scenarios I could encounter, yet no one was willing to address how to do a cricothyroidotomy. My Dad showed me how...in principle!

With the appropriate caveats I still think it should be included in first aid training. Otherwise the person will die or the chances of completely botching up a cricothyroidotomy get really good.

[Rayzerm]

Originally Posted by Dick

No worries, mate. Your caution is warranted and no, it didn't come across as a castigation.

I’ve spent countless hours working in the woods. There was usually only two of us and we were hours from any cell phone coverage (hell, I don’t have a cell phone anyway!), and possibly hours from our truck radio. Even with radio access I’m pretty much on my own, although trying to contact a doctor does make a lot of sense.

Sometimes I’d have 30 tree planters out there with me, and I’d have no knowledge of allergies etc.

By my reckoning the likely scenarios I could expect to deal with were puncture wounds from falling, or from a critter attack; fractures etc. from ATV / snowmachine roll over; eye punctures; dehydration; hypothermia; frost bite; and anaphylaxis.

True to my nature i wanted to be prepared, at the very least, for the most likely scenarios I could encounter, yet no one was willing to address how to do a cricothyroidotomy. My Dad showed me how...in principle!

With the appropriate caveats I still think it should be included in first aid training. Otherwise the person will die or the chances of completely botching up a cricothyroidotomy get really good.

I guess everybody's situation, and the possible risks they face, are different. I am used to working in a well connected / supplied situation where help is at hand.
I do understand where you are coming from.
As I see it, there are a few possible options regarding training.....

Basic First Aid - I think you will have covered this already (I lump Occupational First Aid into this as well)

EMFR (Emergency Medical First Responder)
This is several steps up from First Aid, but not full EMT / Paramedic
You get much more detailed training on a much wider range of topics and treatment methods, as well as "ride-alongs" to show you the ropes in practice

Paramadic
Speaks for itself - and is more a career than side training

EMFR training takes a certain commitment, both in time and effort, but would give you a good knowledge base if you are out with a lot of people under your supervision. Maybe worth checking out some local trainers.

I visited several planting scheme's in Ontario a few years back so, yeah, I know what you are talking about when you say you are far away from things. It took us over an hour just to drive from the highway to the base camp, and the work parties were another hour out from there.....

[snowshoe67]

Well I Thank you all (CW) Thanks for the great info. I have taken a basic First aid class but I'am proud of Myself keeping Mt C.P.R Card up dated. Super Important !!

[Camdor]

Originally Posted by Celticwarrior

Indeed. Trach's are actually never meant to be done in the field unless ABSOLUTELY NECESSARY. I have gone over this in a couple of other threads, because people watch trauma shows on TV and think anyone with a penknife and a straw can do one. In reality, only paramedics with a SURGEON on the radio with them, would be doing an emergency trach/crich. If you have that kind of training, and want to learn how to do one, there are resources on the web to show you the proper technique, but if you aren't 100% about the anatomy, you could permanently paralyze that person, destroy their vocal cords, botch the crich and destroy the windpipe (which would kill them), or nick a major blood vessel and watch them bleed out in seconds. Don't blame any instructor for NOT teaching you this technique. They shouldn't EVER be doing so. This is something that only a highly trained paramedic, under the direct guidance of a surgeon or emergency medical supervising doctor, should attempt, and even then there are risks. They will almost ALWAYS go for a needle, not a cut and tube, because it's the safest way. Big bore needles will give enough airflow to allow bagging until transport to the hospital can occur and a REAL surgeon can make incisions and/or clear the airway properly for intubation. The ONLY time a trach/crich is called for is if the windpipe is so grossly blocked or crushed that removal of the object or mitigation of the trauma is impossible before the victim chokes to death. Unless that is the case, you should always be looking at sweeping the throat for obstructions, doing a Heimlich maneuver, or other methods of clearing the airway. Cutting should be the absolute last idea you have in the field, especially if you are not properly trained for it.

Agreed

When I was in the field, we were trained on how to do what is called a Thoracostomy, or chest tube insertion, as well as trachs and, as you said, it was always to be done with either a trauma surgeon of trauma doc online. Chest tubes are somewhat safer but still last resort.

Anyone who claims to be able to teach a layman how to do either via a first aid course should be reported immediately and avoided at all costs.

My opinion.