Cricothyrotomy Flashcards
Cricothyrotomy
- “the establishment of a surgical airway through the cricothyroidmembrane
- Surgical- insertion of a cuffed tracheostomytube or ETT
- Percutaneous
- With the use of a large bore needle
Cricothyrotomy Why
To provide oxygenation and ventilation.
Cricothyrotomyis best thought of as a rescue technique to be performed if airway capture cannot be achieved by other means.
Where Cricothyrotomy
In emergency departments and in “the field”
Who Performs A Cricothyrotomy
Inserted by highly skilled personnel (surgeons, ER physicians, paramedics
How Long Should A Cricothyrotomy Be In Place
Less than 24 hrs. In that 24 hrs alternate airway should be established.
(ie. Tracheostomy)
Indications for Cricothyrotomy
1) Can’t intubate, can’t oxygenate. (CICO)
2) Can’t intubate, can oxygenate but all other available methods of intubation have failed or are deemed likely to fail.
3) Intubation is contraindicated or believed to be impossible.
Absolute Contraindicatiosn Cricthyrotomy
Young age – <5 years, should not be attempted
(Percutaneous only for children 2-5 years)
Relative Contraindicatiosn Cricthyrotomy
1) Pre-existing laryngeal or tracheal pathology
2) Hematoma
3) Coagulopathy
4) Lack of operator expertise
Surgical Procedure
Rapid Four-Step Technique
(1 person technique)
- Palpate and identify landmarks
- Make Surgical Incision
- Apply Traction
- Intubate and Confirm Placement
Surgicial Incision With Rapid Four Step Technique
single, horizontal incision, 1.5 cm through both skin and cricothyroid membrane
Surgical Procedure
No Drop Technique
(2 person technique)
1) Identify the landmarks
2) Prepare the neck
3) Immobilize the larynx
4) Incise the skin- 2-3cm, midline, vertical
5) Re-Identify Membrane
6) Incise the Membrane-1 cm, horizontal lower half of membrane
7) Insert tracheal hook
8) Insert the Trousseau dilator
9) Insert the tracheostomytube
10) Inflate the cuff and confirm tube position
Percutaneous Procedure (needle cricthyrotomy)
1) Identify the landmarks
2) Immobilize the larynx
3) Insert transtrachealneedle
4) Advance catheter
5) Confirm location
6) Connect to bag or jet ventilation
Perform jet ventilation
Jet Ventilation
Adult
Jet ventilator should be connected to a 50 psi source (ideally pressure can be titrated to lowest pressure required to deliver a tidal volume)
I:E of 1:3
Difficult Cricothyrotomy
S.H.O.R.T.
S- Surgery or other airway disruption, Radical neck
H- Hematoma (and/or infection, abscesses)
O- Obesity
R-Radiation distortion (scar tissue)
T- Tumor
Immediate/Short Term Complications
- Hemorrhage
- Laryngeal/Tracheal Injury
- Subcutaneous emphysema
- Pneumomediastinum
- Infection
- Barotrauma/Volutrauma
