Cricoid pressure: evidence and practice

You've probably performed a few RSIs in your anaesthesia practice. But have you though about all the techniques you do to make this inherently risky technique safer?

In this episode we chat about the approach to the question from the April 2014 and September 2013 SAQ paper

Describe the physiological basis of methods used to prevent hypoxaemia prior to intubation in a rapid sequence induction. Include any adverse effects of these methods.

 The exam paper
https://networks.anzca.edu.au/d2l/le/content/7669/Home?itemIdentifier=D2L.LE.Content.ContentObject.ModuleCO-86745

Atomic Habits summary by James Clear
https://www.samuelthomasdavies.com/book-summaries/self-help/atomic-habits/

The book
https://jamesclear.com/atomic-habits

Interview with James Clear on Making Sense Podcast with Sam Harris
https://samharris.org/subscriber-extras/200-creatures-habit/

Plateau of Latent potential
https://i0.wp.com/www.samuelthomasdavies.com/wp-content/uploads/2019/01/The-Plateau-of-Latent-Potential-1.png?w=2000&ssl=1

Bleomycin and oxygen toxicity
https://www.mayoclinicproceedings.org/article/S0025-6196(12)60489-3/fulltext

Oxygen therapy for sats <94% in acute coronary syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4952356/

Alveolar gas equation for FiO2 100%
FiO2 (Patmos - PH2O) - pCO2/R
1.0(760-47) - 40/0.8
713 - 50
= 663mmHg

for FiO2 at room air of 21%
0.21 (713) -50
= 99.7mmHg
~ 100mmHg

Cricoid - 20N applied to the cricoid cartilage to cause external pressure constricting the oesophagus and thereby decreasing the chance of aspiration. 
BUT
Increases the time to intubation
Impairs the laryngoscope view
No proven benefit
Can cause discomfort



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