TissueDB/Simulators/Cricothyroidotomy Simulator (Gauger)

The Cricothyroidotomy Simulator (Gauger) is a trainer for emergency needle cricothyroidotomy — the final, life-saving step when a patient cannot be intubated or oxygenated. Using a 3D-printed laryngotracheal model set in a mannequin, a learner palpates the surface landmarks, inserts a 14-gauge Ravussin needle through the cricothyroid membrane into the trachea, slides the cannula off the needle, and then delivers oxygen through the cannula with the Meditech Rapid-O2 Cricothyroidotomy Insufflation Device.^[1]

1. Obtain a laryngotracheal anatomical dataset and prepare it as a CAD model because Gauger et al. 2018 produces the model with CAD and 3D printing (citing Kovatch et al., reference [8], for the pipeline) but does not specify the source anatomy or the imaging modality used; an institutional or local equivalent will be required to reproduce the model.^[1]
2. Fabricate a 3D-printed laryngotracheal model from medical-grade silicone because Gauger 2018 names medical-grade silicone as the build material; the exact silicone grade, durometer, printer system, slicing parameters, and the 3D-to-silicone route are not specified in the paper and will need to be selected locally.^[1]
3. Inspect the fabricated silicone model and confirm that the cricothyroid-membrane region accepts a clean 14-gauge needle puncture because the target structure must yield cleanly to the Ravussin cannula for the oxygen-insufflation step to seat correctly.

1. Seat the 3D-printed silicone laryngotracheal model within the mannequin because Gauger 2018 describes the model as incorporated into a mannequin for procedural training.^[1]
2. Align the silicone model so that the cricothyroid-membrane region sits beneath the external skin at the anatomical midline because learners palpate surface landmarks before needle insertion and misalignment would invalidate the surface-anatomy training cue.
3. Confirm the trachea of the silicone model is open distally so that an inserted cannula tip sits freely in the tracheal lumen because oxygen delivered through the Rapid-O2 device must vent freely into the trachea.

1. Provide an external skin layer over the laryngeal anatomy because Gauger et al. (2018), Figure 1, shows the model with its external skin removed to reveal the tracheal model — the deployed model carries an outer skin surface for landmark palpation.^[1]
2. Note that Gauger 2018 does not specify the skin's material, whether it is printed integrally or applied as a separate covering, how it is secured, or a replacement protocol; a builder will need to define these locally for reproducibility.

1. Connect the Meditech Rapid-O2 Cricothyroidotomy Insufflation Device to an oxygen source (wall oxygen or a portable cylinder; source not specified by Gauger et al. 2018) and set the device per the manufacturer's instructions because the Rapid-O2 device supplies the oxygen learners deliver after cannula placement.^[1]
2. Prepare a single-use 14-gauge Ravussin needle/cannula and verify the Rapid-O2 attachment port matches the cannula hub because a mismatched connector would block oxygen delivery.
3. Note for reproducibility: in the source study the Ravussin needle and Rapid-O2 device were provided to learners contained within a blue plastic bag (Gauger et al. 2018, Figure 1); the paper describes no functional role for the bag.^[1]

1. Have the learner palpate the cricothyroid landmarks — the thyroid cartilage, cricothyroid membrane, and cricoid cartilage — on the model's external skin because identifying the landmarks is the first step of the CSMP Checklist (Gauger 2018 names only "identifies landmarks"; these three are the standard front-of-neck-access landmarks, not separately enumerated by the source) and the trainer's principal target.^[1]
2. Have the learner attach a saline-filled syringe to the Ravussin cannula and stabilize the cricothyroid with the non-dominant hand because the CSMP Checklist scores both steps before the needle is inserted.^[1]
3. Have the learner insert the 14-gauge Ravussin needle/cannula through the external skin and the silicone cricothyroid membrane into the tracheal lumen while aspirating because the CSMP Checklist scores inserting through the cricothyroid membrane while aspirating.^[1]
4. Have the learner slide the cannula off the needle into the trachea and withdraw the needle, leaving the cannula in place, because these are the cannula-seating and needle-removal steps of the CSMP Checklist.^[1]
5. Have the learner reconfirm position by aspiration of air and then stabilize/secure the cannula because the CSMP Checklist scores reconfirming position and securing the cannula before oxygenation.^[1]
6. Attach the Meditech Rapid-O2 device and deliver oxygen through the cannula because this completes the front-of-neck oxygenation step the trainer is built to rehearse.^[1]

1. Reset the silicone laryngotracheal model between learners (replacement / cleaning protocol not described by Gauger et al. 2018; local practice will need to define whether the silicone is reused, whether the external skin layer is replaced, and how prior puncture sites are managed).
2. If the external skin layer is compromised by prior punctures it will likely need repair or replacement before the next learner (no skin-replacement protocol is described by Gauger et al. 2018).
3. Load a fresh 14-gauge Ravussin needle/cannula for each learner because the cannula is a single-use consumable.

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