4 | Cricoid Pressure + External Laryngeal Manipulation

cricoid pressure

Posterior pressure on the cricoid cartilage is referred to as […].

cricoid ring

Because the […] is the only complete ring in the trachea, posterior pressure on the front of the ring is transmitted to the back of the ring.

complete ring

The cricoid ring is the only […] in the trachea.

esophagus

Posterior pressure on the front of the cricoid ring is transmitted to the back of the ring and, it is hoped, compresses the […] between the back of the cricoid ring and the front of the spinal column.

spinal column

Posterior pressure on the front of the cricoid ring is transmitted to the back of the ring and, it is hoped, compresses the esophagus between the back of the cricoid ring and the front of the […].

rapid sequence intubation (RSI)

This maneuver became popular with the advent of […] as a means to limit regurgitation and subsequent aspiration.

regurgitation

This maneuver became popular with the advent of rapid sequence intubation (RSI) as a means to limit […] and subsequent aspiration.

aspiration

This maneuver became popular with the advent of rapid sequence intubation (RSI) as a means to limit regurgitation and subsequent […].

risk-to-benefit ratio

Recent evidence suggests that the […] may not actually favor cricoid pressure during intubation.

cricoid pressure

Recent evidence suggests that the risk-to-benefit ratio may not actually favor […] during intubation because when applied correctly to compress the esophagus, it often obscures the intubator’s view of the larynx.

intubator’s view of the larynx

Cricoid pressure often obscures the […] when applied correctly to compress the esophagus.

lower-esophageal sphincter tone

The pressure itself causes a reflex decrease in […], actually working against the intended aspiration-sparing effect.

aspiration-sparing effect

The pressure itself causes a reflex decrease in lower-esophageal sphincter tone, actually working against the intended […].

cricoid pressure usage

[…] specifically during BVM ventilation (not as a technique to improve laryngoscopic view) can still be of some benefit according to clinical research despite the skill falling into disfavor.

BVM ventilation

Cricoid pressure usage specifically during […] (not as a technique to improve laryngoscopic view) can still be of some benefit according to clinical research despite the skill falling into disfavor.

clinical guidelines

Due to these conflicting views on its efficacy, in any instance where cricoid pressure can be attempted, the EMS practitioner should ensure that the skill is still approved by […] or, at the very least, by online medical direction.

online medical direction

Due to these conflicting views on its efficacy, in any instance where cricoid pressure can be attempted, the EMS practitioner should ensure that the skill is still approved by clinical guidelines or, at the very least, by […].

cricoid pressure

Because some practitioners can still use […] under specific criteria, the skill to do so properly is discussed here.

cricoid cartilage

To locate the […], first palpate the thyroid cartilage and feel the depression just below it (cricothyroid membrane).

thyroid cartilage

To locate the cricoid cartilage, first palpate the […] and feel the depression just below it (cricothyroid membrane).

cricothyroid membrane

To locate the cricoid cartilage, first palpate the thyroid cartilage and feel the depression just below it ([…]).

cricoid ring

The prominence inferior to this depression is the […].

anterolateral aspect of the cartilage

Apply firm downward pressure to the […] using the thumb, index, and middle finger of one hand.

deform

Use caution not to apply so much pressure as to […] and possibly obstruct the trachea; this is a particular danger in infants.

obstruct the trachea

Use caution not to apply so much pressure as to deform and possibly […] ; this is a particular danger in infants.

infants

Use caution not to apply so much pressure as to deform and possibly obstruct the trachea; this is a particular danger in […].

50-mL syringe

The necessary pressure has been estimated as the amount of force that will compress a capped […] from 50 mL to the 30 mL marking.

30 mL marking

The necessary pressure has been estimated as the amount of force that will compress a capped 50-mL syringe from 50 mL to the […].

release the pressure

In the event that the patient actively vomits, it is imperative to […] to avoid esophageal rupture.

esophageal rupture

In the event that the patient actively vomits, it is imperative to release the pressure to avoid […].

cricoid pressure

[…] is pushing the cricoid cartilage posteriorly to compress the esophagus behind it.

external laryngeal manipulation (ELM)

[…] is a technique in which the thyroid cartilage is moved laterally to improve laryngeal view during intubation.

thyroid cartilage

In external laryngeal manipulation (ELM), the […] is moved laterally to improve laryngeal view during intubation.

cricoid cartilage

Cricoid pressure pushes the […] posteriorly to compress the esophagus behind it.

laryngeal view

External laryngeal manipulation (ELM) is used to improve […] during intubation.

difficult intubations

ELM is an effective means of improving […] and is often used with direct laryngoscopy.

direct laryngoscopy

ELM is an effective means of improving difficult intubations and is often used with […].