2019 PALS Review: A Link To “Pediatric Needle Cricothyrotomy: A Case For Simulation In Prehospital Medicine

This is part of my review and preparation for my upcoming Pediatric Advanced Recertification Course.

Please see also my post 2019 PALS Review – How To Perform Pediatric “Percutaneous Needle Tracheostomy (PNT) Procedure” On YouTube
Posted on January 3, 2019

Here is a link to a useful simulation case:

Pediatric Needle Cricothyrotomy: A Case for Simulation in Prehospital Medicine from MedEdPORTAL – The Journal of Teaching and Learning from the Association of American Medical Colleges.The article contains links to ten  appendices that you must download and review. The content is in the appendices.

Here is a Link To Download all of the Appendices which are zip files. And here is a list of the files:


  • Simulation Case.docx
  • PowerPoint Presentation.pptx
  • Participant Evaluation Tool.docx
  • Pre- and Posttest.docx
  • Fetal Pig Model.docx
  • Hardware Store Model.docx
  • Correct Procedure Technique Explained.docx
  • Needle Kit Image.JPG
  • Angioedema Image.JPG
  • Urticaria Image.jpg

All appendices are peer reviewed as integral parts of the Original Publication.

Here are two excerpts from the above article:


Introduction: A patient that cannot be oxygenated or ventilated requires immediate and effective assessment, treatment, and transportation. Pediatric needle cricothyrotomy is used infrequently, therefore providers have a tendency to lose proficiency. Simulation training and evaluation are valuable tools to improve provider experience and skill. Methods: A case was designed involving a 3-year-old male with a peanut allergy that presents with rash, swelling, and severe respiratory distress. The patient’s respiratory distress and swelling worsens despite treatment with epinephrine and other allergic reaction medications. The patient then becomes unresponsive and impossible to oxygenate or ventilate. The primary objective of this case is airway management with needle cricothyrotomy in the pediatric population. A secondary objective is appropriate postprocedure management including appropriate ventilation rates and emergency medical transportation methods. Results: This case was initially presented to 45 paramedics. Provider comfort with managing airway emergencies in young children improved from 47% to 89%. Confidence in performing pediatric needle cricothyrotomy improved from 16% to 87%. All providers felt the exercise was valuable and 98% felt the simulation provided appropriate realism. Discussion: This scenario provides an outstanding opportunity for paramedic evaluation and training in pediatric needle cricothyrotomy and significantly improved the comfort level of providers’ management of a failed pediatric airway. As we reflected on the use of this module, it was apparent that this was a very beneficial opportunity to spend one-on-one time between participants and their medical director. The training staff also benefited from the repeated emphasis of good assessment and treatment of a complex patient scenario.


This educational module is centered on a pediatric “can’t intubate, can’t ventilate” scenario in the prehospital setting. It can be utilized by emergency medical services (EMS) training departments or medical directors to provide continuing education and an objective way to evaluate a provider’s ability to negotiate this type of critical care patient encounter. The case itself is presented in the simulation case file (Appendix A) that includes information needed to implement this case. A PowerPoint presentation (Appendix B) suitable for use before or after participants have completed the case is available, along with a participant evaluation tool (Appendix C) and a pre- and posttest (Appendix D).

This case can be implemented using equipment such as a Laerdal SimJunior, Life/form Complete Child CRiSis Manikin, or another appropriate high-fidelity patient simulator. Alternatively, with a few modifications the case can also be completed using low-fidelity patient mannequins or even used in an oral board presentation format. To fully implement this teaching module, all formats will require a separate skill completion component. This can be performed on either on a cadaveric fetal pig (Appendix E) or an artificial low-cost “hardware store” model (Appendix F). An additional document explaining the correct procedures for airway management and needle cricothyrotomy (Appendix G) is also included, as are files containing visual stimuli (Appendix H-J). This case can be presented with a single evaluator providing case information and role-playing various aspects of the case. The case may be enhanced with additional actors serving as detailed in the case file.

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