Mod 2 Difficult airways 2 Flashcards
What are Cricothyrotomy’s
Establishment of a surgical airway through the cricothyroid membrane
- open incision and insertion of a cuffed tracheostomy tube (or ET)
What is the Seldinger technique?
Using a guide wire to establish a airway via needle.
- could dilate with the wire
- Tube is guided the wire
- uses a large bore needle (12-26 gauge) catheter
Is sizing of hole larger based on a larger needle gauge size?
No. For needle gauges, the smaller the number the bigger the hole
How long should a Cricothyrotomy be left in as a airway?
Less than 24hrs
- within that 24hrs a alternate airway should be established
surgical vs percutaneous Cricothyrotomy?
Indications for Cricothyrotomy? (3)
- Can’t intubate, can’t oxygenate (CICO)
- Can’t intubate, can oxygenate but all other available methods of intubation have failed or deemed likely to fail
- Intubation is contraindicated or believed to be impossible
Absolute contradications Cricothyrotomy?
Younge age < 10 years of age
- needle cric is the technique of choice if.they are less than 10
Cricothyrotomy technique for pts 5-10yrs?
Seldinger technique
Cricothyrotomy technique for pts <5?
Needle only
Relative contradications Cricothyrotomy? (4)
- Pre-existing laryngeal or tracheal pathology
- Hematoma
- Coagulopathy (pt doesn’t clot)
- Lack of operator expertise
What is the primary and more recent preferred technique for Cricothyrotomys in adults?
Scalpel finer bougie procedure
- make incisions, palpate w/finger, insert via finger in place of bougie, replace bougie w/ett
What is Percutaneous Procedure (needle circthryotomy)
- Identify the landmarks
- Immobilize the larynx
- Insert transtracheal needle
- Advance catheter
- Confirm location
- Connect to bag or jet ventilation
- Perform jet ventilation
For needle cricothyrotomys, why does the needle have saline when inserting?
Saline will bubble and will help confirm placement
Why might a needle or seldinger technique be chosen over a regular incision
What ventilation method is used if a percutaneous trach is inserted?
Jet ventilation
- connected to a 50 psi source
- 1 second insp: 3 seconds exp