Landmarks for tracheostomy and cricothyrotomy

Question 1

Answer 1

Question 2

What differences are there between the male and female surface anatomy of the anterior neck?

Answer 2

• Men: thyroid cartillage (adam’s apple) is much more prominent
• Women: **cricoid cartillage **is often easier to see and palpate

Question 3

Answer 3

Question 4

What is punctured to perform a cricothyrotomy and how is this located?

Answer 4

Skin, sub-cutaneous fascia and the avascular cricothyroid membrane

1. Identify thyroid cartillage
2. Slide finger off lower border of thyroid cartillage to find cricothyroid membrane
3. Ring of cricoid cartillage should be below finger in 6 o’clock position

Question 5

At what vertebral level is the cricoid cartilage in the adult?

Answer 5

C6 in the adult

Question 6

How do you identify the correct site for a tracheostomy?

Answer 6

• Correct site for tracheostomy is **second and third tracheal rings. **
  Higher sites are associated with increased risk of tracheal stenosis
• Draw vertical line from sternal notch to lower border of cricoid cartillage and mark the midpoint of this line - should be between the second and third tracheal rings
• Note the isthmus of the thyroid gland may lie across or just below this point.

Question 7

What are the differences betwen the sites for cricothyroidotomy and tracheostomy?

Answer 7

Cricothyroidotomy: cricothyroid membrane superior to the cricoid cartillage
Tracheostomy: inferior to cricoid cartillage, mid-way between it and the sternal notch, between 2nd and 3rd tracheal rings.

Question 8

What vascular struture may be damaged during a percutaneous tracheostomy, and how can this be identified

Answer 8

Although not clearly visible in the majority of patients, there are often vessels both arterial and venous which can cross the anterior aspect of the trachea.

In particular:** Anterior jugular vein**

May be identified by
- Valsalva manouvre in conscious patient
- Ultrasound of neck