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I almost choked to death last night....


Reuben Kinkaid

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I got your back, homie. You're 12oz's own Hank Hill, a narrow esophagus having motherfucker.

 

Shit, Reuben was so thankful that he was telling his girl that she owed me a blowjob, haha. And yeah, we did go back to drinking beer like nothing happened and proceeded to make fun of the tattooed emo homos working the counter before we were interrupted.

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So me and 12oz's own Hydrogen Peroxide were grabbing a burger before we hit the bar, and I feel a piece get lodged in my throat. I drink some beer to try and wash it down but it just sits there in my throat and I realize I can't breath. I start motioning to him that I'm choking and I think he thought I was joking until I kind of threw up a little bit of foamy beer. He asks me if I'm seriously choking and I nod, asks if I need the Heimlich and I nod, so we both stand up and he just cranks on me and I just feel everything just whoosh down my throat. It's a good job he was there and new what he was doing because the twinks working the counter just stood there watching and would clearly have been no help at all. We both remained remarkably calm throughout and the whole thing started and ended within about 30 seconds. Then we got drunk. Just thought I'd share because it's only now just sinking in that I could have very easily died last night. So thanks HP.

 

Remember to chew your food people!

 

theoffice-thatswhatshesaid-michael.jpg

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I got your back, homie. You're 12oz's own Hank Hill, a narrow esophagus having motherfucker.

 

Shit, Reuben was so thankful that he was telling his girl that she owed me a blowjob, haha. And yeah, we did go back to drinking beer like nothing happened and proceeded to make fun of the tattooed emo homos working the counter before we were interrupted.

 

I thought Hank Hill had a narrow urethra...

Are you calling Reuben a dickhead after saving his life?

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Indications and Contraindications

 

Cricothyroidotomy is an emergency procedure and must be performed only when a secure airway need to be maintained and attempts at orotracheal and nasotracheal intubation have failed. It is contraindicated if any other less radical means of securing airway is feasible.

 

Anatomy

 

The cricothyroid membrane lies between the thyroid cartilage superiorly and the cricoid cartilage inferiorly. It can be felt by palpating the neck anteriorly and finding first the thyroid cartilage that is the most prominent cartilage in the neck. After that you need scroll down your index finger until you can fell the space between the thyroid and cricoid cartilages. This space is the place of the cricothyroid membrane. The image below will help you to find it.

cricotir.gif

 

Materials

 

1-Material for sterile technique(gloves, mask, cap and gown)

2-Povidone-iodine solution for sterilizing the skin

3-Sponges

4- Drapes and rolled bath towel

5-No. 11 scalpel blade.

6-1% lidocaine without epinephrine in a 10-cc syringe with a 25-gauge needle

7-Two mosquito or two kelly clamps

8-Low pressure cuffed tracheostomy tube

9-A 10-cc syringe to inflate the balloon on the tracheostomy tube

10-Bag valve mask (Ambu) connected to a oxygen source

11- Adhesive tape

 

Technique

 

As an emergency procedure in some cases you perhaps will not have time to follow all the steps listed below. Nevertheless, it is very important to sterilize the skin and observe sterile technique.

 

1- Prepare all necessary equipment and test the tracheostomy tube by inflating the tube with air from 10-cc syringe. Place the material on a sterile towel placed on a Mayo stand or bedside table.

 

2- One of the most important aspects is to position the patient . He or she should be supine, with a rolled bath towel under the shoulders, and with the neck in hyperextension.

 

3- Sterilize the skin from the sternal notch to chin and laterally to the base of the neck.

 

4- Observe sterile technique

 

5- Identify the cricothyroid membrane as described above

 

6- Anesthetize the skin over the membrane using the 10-cc syringe with 25-gauge needle with the 1% lidocaine.

 

7- Make a transverse incision of the skin over the cricothyroid membrane using the No. 11 blade.

 

8- Identify the membrane and then continue the incision through it. approximately 1 cm on each side of the midline.

 

9- With the mosquito or kelly clamp in the left hand, insert the clamp into the incision and spread it . This is sufficient to provide an airway for a patient with supraglotic airway obstruction.

 

10- With the right hand insert the tracheostomy tube or the orotracheal tube through the incision into the trachea, directing it caudally.

 

11- Connect the bag-valve unit to the tube and ventilate the patient the patient with 100% oxygen.

 

12- Observe respiratory movements of the chest and breath sounds.

 

13- Inflate the tube balloon

 

14- Cut a sponge halfway down the middle, and wrap it around the tube if an orotracheal tube is being used and then fashion a necklace to place the tube in place. If you are using the tracheostomy tube secure the wings of the tube by tying the tapes around the patient's neck. In both cases don't tying the tape to tightly because it can cause erosion the skin.

 

15- Suction the trachea

 

16- Obtain a chest x-ray to check the position of the tube.

 

Complications

 

This procedure when done with a rigorous attention on anatomic landmarks rarely leads to complications.

 

Bibliography

 

Charles E. Saunders, Mary T. Ho(eds): In Current Emergency Diagnosis and Treatment. Fourth edition, 1992.

 

read it

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