A "last ditch" airway.
In a patient whose airway is in jeopardy after unsuccessful attempts at conservative measures to clear it and after failed attempts at intubation, the intravenous tubing connector spike may be considered as an emergency percutaneous tracheostomy device. It is readily available wherever physicians have intravenous solutions at hand. It is inserted through the cricothyroid space with the help of a scalpel blade or other sharp instrument such as a pair of scissors. A severed spike can be as easily carried in a pocket, purse or medical bag as can an intravenous cannula. A number 11 scalpel blade fits neatly between two credit cards. The shape of the spike makes it fortuitously adaptable to intermittent positive pressure ventilation by mouth or standard resuscitation equipment. If the patient is otherwise well enough, it is of sufficient bore to allow spontaneous respiration. I have been fortunate not to have had the opportunity to use this device in an emergency situation as of the time of the submission of this paper.