Next time you are hanging out, happen to have spare airway tubes and IV sets sitting around, and want to impress your medical geek friends with some SOF Medical Magic, throw together a Macguyver Cric.  It’s a great conversation starter if not a great airway…..

The following story highlights a bit of SOF medical gadgetry that may or may not be real.  Lots of folks have heard of this bit of medical coolness, few have actually used it.

The usual disclaimers apply – this is not medical advice.  As configured, the equipment demonstrated in this article isn’t approved by any medical authority, is not FDA approved, and has not been studied in any controlled manner.  Suffice to say, this is off-the-record, no shit hasty and temporary.

This is graphic……and, oh by the way, this never happened.

A long time ago, in a galaxy far far away……I was part of a medical team that treated an adult male after he attempted to kill himself with his personal weapon.  He did the typical hollywood drama shot, with the pistol pointing vertically while he held it under his chin.  He fired one round that shredded his jawbone and lower face.  Sadly, he missed his brain entirely and survived.  (Its tragic that he tried to kill himself in the first place, it just got worse when he missed…)

Without any bony structure, his lower face and blood kept falling back into his throat, choking him.  He was terrified, in severe pain, and desperate to die.  Worse yet, every time we tried to lay him down to put in a breathing tube, he’d choke more and start swinging and kicking us.  We couldn’t get close to the guy’s neck to perform a surgical airway without getting kicked and punched.  Not knowing where the bullet had traveled, we decided that a blind insertion of any kind of tube through his face could possibly penetrate his brain.  Fortunately, the patient could sit up, lean forward, and hold the shreds of his face out of the way to get a short breath on his own. (Its amazing how a person will protect their own airway if allowed).

This guy was in a bad way and we were in a bind.  There are only a couple airway maneuvers you can use when you can’t lay a person flat.  They require a very cooperative patient, an anatomically intact airway, and no risk of riding a bullet tract into the brain.  We had to “cric” the guy but we couldn’t get close to his neck and no one wanted to be punched while holding a scalpel.

The challenge – perform a cricothyroidotomy while the patient is sitting up and swinging his fists at you.