Coniotomy and Tracheostomy

Question 1

What is the definition of tracheotomy?

Answer 1

This is a surgical procedure which involves making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the neck.

A tracheostomy tube may be needed if the patient requires long-term mechanical ventilation, frequent suctioning to manage secretions, or to bypass airway obstructions. The procedure is usually performed in the operating room.

Question 2

What is the definition of coniotomy?

Answer 2

• Also known cricothyroidectomy
• It is used to establish a patent airway during certain life-threatening situations.
• It’s uses include airway obstruction by a foreign body, angioedema, or massive facial trauma.
• It involves the surgical creation of a trasversal section between the thyroid and cricoid cartilages, through the median cricothyroid ligament.

Question 3

The following layers are pierced:

Answer 3

• Skin and subcutaneous tissue
• Lamina superficialis fasciae cervicalis (superficial fascia of the neck)
• Lamina pretrachealis fasciae cervicalis (pretracheal fascia)
• Median cricothyroid ligament and mucosa

Question 4

Indications of tracheostomy:

Answer 4

Airway obstruction, mechanical ventilation, facilitation of secretion managment

Airway protection, facilitation of weaning from mechanical ventilation, facilitating of long-term intensive care and management, obstructive sleep apnea

Question 5

Indications of coniotomy:

Answer 5

Upper airway obstruction by a foregin body, angioedema, or massive facial trauma.

Failed endotracheal intubation, Emergnecy airway access, inability to ventilate, obesity and limited resourced

Question 6

How to ventilate using coniotomy?

Answer 6

First, ensure the patient is correctly placed (head tilt chin method) and there are no obstructions to the procedure. Prepare all the supplies.
Second, palpate the cricothyroid membrane, disinfect the area and make an incision.
Third, cut open the trachea and open it with a trachea hook.
Fourth, advance the bougie 10-15cm into the airway. Suction to ensure that the lumen is clear. Slide the tube down the bougie.
Fifth, remove the bougie and inflate the cuff with 10cc of air.
Attach the bag valve mask and ensure the device is correctly placed. Perform ventilation.

Question 7

Advantages of tracheostomy over endotracheal intubation:

Answer 7

Faster weaning
Enhanced patient comfort and communication
Possibility of oral feeding
More effective clearing of secretion

Question 8

Indications of coniotomy:

Answer 8

Upper airway obstruction
Inability to intubate, ventilate
Facial trauma
Cervical spine trauma

Question 9

Indications of tracheostomy:

Answer 9

Long-term ventilation
Frequent suctioning to manage secretions
Bypass airway secretion