CRICOTHYROTOMY

Question 1

MANAGEMENT

Answer 1

10 Scalpel

INDICATION
Cannot oxygenate, ventilate, or intubate due to:
Upper airway obstruction
Larygeal Spasm
Facial deformity/trauma
Trismus
Blood/vomitus in airway
Failed intubation

CONTRAINDICATIONS
Presence of alternative methods to oxygenate, ventilate, and secure the airway
Child younger than 8-12 years old
Airway obstruction located at or below the cricothyroid membrane

EQUIPMENT

6 Cuffed ETT OR Tracheostomy tube
preloaded on Bougie
10-mL syringe (inflate the cuff)
Kelly Clamp
Arterial Forceps
PPE

TECHNIQUE

Extend the neck with a towel roll under the shoulders (“laryngeal handshake”)

Stand on right side of patient

Stabilize lower thyroid cartilage with non-dominant hand with thumb and middle finger

Push skin taut

Palpate cricothyroid membrane with non dominant index

Hold scalpel with dominant hand, can rest on sternum for support.

Make a 4cm vertical incision over cricothyroid membrane deep to fat layer.

Palpate the cricothyroid membrane with non-dominant index ± blunt dissect with forceps until membrane is
visible.

Make a horizontal incision through the cricothyroid membrane.

Keep scalpel in tracheal. Switch scalpel to non-dominant hand.

Dilate with a kelly clamp

Pass a bougie alongside the finger into the trachea

Confirm bougie placement with finger (should also get holdup at the carina ± sensation of tracheal rings).

Pass ETT over the bougie. May need to corkscrew the ETT to advance. Advance the
ETT until the cuff is no longer visible.

Hold the ETT in place and remove the bougie.

Confirm placement with ETCO2 + adjunctive measures (CXR, misting, chest rise, etc).

Connect to BVM!

POST-PROCEDURAL CARE
Confirm placement with end-tidal C02 detector
Aucultate bilatererally
Secure tube