TissueDB/Simulators/Cricothyrotomy Simulator (Muller)

This open surgical cricothyrotomy trainer is made by fitting a commercially available manikin with low-cost expendable supplies — a Microfoam-tape cricothyroid membrane and a replaceable porcine-skin incision surface — so trainees can drill the scalpel–finger–bougie technique.^[1] The base is a Strategic Operations Inc. 3-in-1 TCCC patient simulator; the Microfoam-tape patch on its removable laryngeal insert is the cuttable surface that stands in for the cricothyroid membrane, and the porcine skin over the neck gives the scalpel incision surface. The trainee locates the landmarks, incises the membrane, passes a bougie into the airway, and advances a cuffed endotracheal tube over it — the Bougie-assisted variant of the scalpel-finger-tube technique of Paix and Griggs.^[2] Developed and evaluated with U.S. Army first responders by Muller and colleagues (Muller et al., Military Medicine, 2020).

The paper's half-day training protocol (presentation, anatomy review, palpation practice, technique demonstration citing Paix and Griggs 2012, twice-supervised practice) is pedagogical content and is documented separately in the associated SELF Module (not on this build page).

1. Obtain a Strategic Operations Inc. 3-in-1 TCCC manikin patient simulator because the paper evaluates its airway geometry as the simulation substrate (Muller et al. 2020, Fig. 2).
2. Remove the laryngeal insert from the manikin to expose the internal airway structures, because the paper confirms the manikin allows easy removal of internal parts for placement verification (Muller et al. 2020).
3. Adhere a 3-inch 3M Microfoam tape patch to the laryngeal insert at the cricothyroid membrane location because this simulates the cricothyroid membrane as the cuttable surface (Muller et al. 2020).
4. Coat the internal model structures with a light film of Surgilube because this reduces artificial manikin friction during ETT advancement (Muller et al. 2020).
5. Reinsert the laryngeal insert into the manikin body.
6. Place a new section of porcine skin over the laryngeal structures at the external neck because this provides the scalpel incision surface for the skin incision of the scalpel–finger–bougie technique (Muller et al. 2020).

1. Issue one new #10 disposable scalpel per participant because each participant must receive a fresh blade (Muller et al. 2020).
2. Inspect the bougie for serviceability and lay out for reuse because the paper reuses the bougie across participants if serviceable (Muller et al. 2020).
3. Inspect the #6 cuffed ETT for serviceability and lay out for reuse because the paper reuses the ETT across participants if serviceable (Muller et al. 2020).
4. Inspect the 10 cc syringe for serviceability and lay out for reuse because the paper reuses the syringe across participants if serviceable (Muller et al. 2020).
5. Coat the distal portion of the #6 cuffed ETT with a light film of Surgilube because this reduces artificial manikin friction during advancement through the membrane (Muller et al. 2020).

1. Remove and discard the used porcine skin section from the external neck of the manikin.
2. Remove the laryngeal insert from the manikin body and discard the used Microfoam tape patch.
3. Adhere a fresh 3-inch 3M Microfoam tape patch to the laryngeal insert at the cricothyroid membrane location.
4. Re-coat the internal model structures with a light film of Surgilube.
5. Reinsert the laryngeal insert into the manikin body.
6. Place a new section of porcine skin over the laryngeal structures at the external neck.
7. Deflate the #6 ETT cuff with the 10 cc syringe and withdraw the ETT and bougie from the airway, then inspect the bougie, ETT, and syringe for serviceability; retain for reuse if serviceable, replace if not (Muller et al. reuse these between participants if serviceable; the deflation-and-withdrawal sequence is an operational step the source does not detail).
8. Issue a fresh #10 disposable scalpel to the next participant.

1. Confirm success by verifying that a caudally oriented #6 cuffed ETT has passed through the cricothyroid membrane with the cuff fully in the trachea and inflated within the 3-minute time limit (Muller et al. 2020, p. e1781).
2. Remove internal manikin parts to visually confirm ETT placement, because the paper uses direct visualization as the verification method (Muller et al. 2020).

1. Confirm the manikin laryngeal insert is fitted with a fresh 3M Microfoam tape patch — pass/fail.
2. Confirm the internal model structures and the distal portion of the ETT are coated with Surgilube — pass/fail.
3. Confirm a new porcine skin section is placed over the external laryngeal structures — pass/fail.
4. Confirm a fresh #10 scalpel is issued to the current participant — pass/fail.
5. Confirm the bougie, #6 cuffed ETT, and 10 cc syringe are serviceable — pass/fail.