Ch. 19: Surgical Airway Management

Question 1

Surgical Airway Methods

Answer 1

1. Open tracheostomy.
2. Open cricothyrotomy.
3. Wire cricothyrotomy
4. Percutaneous Transtracheal ventilation (PTV) <10yo
5. Surgical via Cricothyrotome.

Cricothyrotomy is placement of cuffed tracheostomy tube or ETT into trachea via the cricothyroid membrane.

Usually a rescue technique for Failed Airway. Could be primary in facial trauma patient.

Question 2

ANATOMY

Answer 2

1. Cricothyroid membrane is more anterior and less vascular than trachea.
2. Find Laryngeal prominence of thyroid cartilage.
3. One finger below is cricothyroid membrane. Above is the thyrohyoid space. Don’t confuse.

Question 3

The No-Drop Technique

Answer 3

1. Need: #11, Trousseau dilator, hook, #4 tracheostomy.
2. Antiseptic, 1% lidocaine skin, 3% via CTM if time.
3. Hold larynx L hand.
4. 2cm vertical incision. Shallow
5. Find membrane then 1cm horizontal lower end of CTM
6. Hook the thyroid cartilage and gently elevate.
7. Trousseau dilator. Vertically and gently enlarge.
8. Insert tracheostomy or bougie and then 6.0 ETT
9. Check ET CO2. Rule out SC placement.
10. Secure in place.

Question 4

The Rapid Four-Step Technique

RFST

Answer 4

At Head of the Bed

1. If anatomy if absolutely CERTAIN incise skin and CTM

with a #20 blade 1.5cm.

2. Hook pulls cricoid out and down. Up and Away 4lb.
3. Insert ETT or Tracheostomy and secure.

Question 5

Seldinger Technique

Answer 5

Usual protocol done from the head of the bed.

Question 6

Percutaneous Transtracheal Ventilation

Answer 6

Rarely used in adults.

Higher incidence of barotrauma

Recommended less than 10 yo