Surgical Cric
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Minutes
Evaluator
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Student
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Skill Steps
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Verbalizes/demonstrates appropriate infection control precautions
Identifies the cricothyroid membrane
Stabilizes the cricothyroid cartilage
Makes vertical midline incision
Attaches syringe to introducer needle
Advances needle through cricothyroid membrane at 45 degree angle towards the feet
Aspirates to confirm needle placement in trachea
Removes syringe
Advances wire guide through the needle into airway
Removes needle leaving wire guide in place
Introduces wire guide into distal tip of handled dilator
Advances dilator assembly over wire until handle rests over cricothyroid membrane
Removes guide wire and dilator simultaneously
Attaches BVM and ventilates
Confirms tracheal intubation
Secures device
Ventilates and oxygenates patient (ventilation rate 8-10 times per minute)
Critical Criteria
Failure to ventilate at the appropriate rate
Failure to successfully intubate the trachea
Failure to maintain visualization of guide wire at all times
Failure to confirm tube placement
Failure to immediately dispose of sharps
Exhibits unacceptable affect with patient or other personnel
Uses or orders a dangerous or inappropriate intervention
Evaluator Comments
Success?
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Pass
Needs Remediation
Signature
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Device
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