Surgical and Nonsurgical Cricothyrotomy EMS 352 DR AQEELA BANO

Surgical and Nonsurgical Cricothyrotomy Used when conventional techniques fail Be familiar with: Anatomy of the anterior aspect of the neck Important blood vessels in area

Open Cricothyrotomy Involves: Incising the cricothyroid membrane Inserting an ET or tracheostomy tube directly into the subglottic area of the trachea Cricothyroid membrane is ideal for surgical opening into the trachea

Open Cricothyrotomy Several types: Open (surgical) cricothyrotomy Modified cricothyrotomy (Seldinger technique) Device that functions as an introducer and an airway Courtesy of Cook Medical

Open Cricothyrotomy Indications Patent airway cannot be secured with conventional means Severe foreign body obstructions Swelling of airway Maxillofacial trauma Inability to open mouth

Open Cricothyrotomy Contraindications Ability to secure a patent airway Inability to identify anatomic landmarks Crushing injuries to the larynx and tracheal transection Underlying anatomic abnormalities Age younger than 8 years

Open Cricothyrotomy Advantages Disadvantages Can be performed quickly Do not need to manipulate cervical spine Disadvantages Difficult to perform in children and patients with short, muscular, or fat necks More difficult than needle cricothyrotomy

Open Cricothyrotomy Complications Severe bleeding from laceration of the external jugular vein. Risks of perforating the esophagus and damaging the laryngeal nerves Taking too long will result in hypoxia Subcutaneous emphysema from tube misplacement

Open Cricothyrotomy Equipment If a commercial kit is not available, prepare: Scalpel ET or tracheostomy tube Commercial device (or tape) to secure tube Curved hemostats Suction apparatus Sterile gauze pads Bag-mask device attached to 100% oxygen

Technique for Performing Open Cricothyrotomy Proceed rapidly yet cautiously Palpate for V notch of thyroid cartilage Slide index finger into depression between thyroid and cricoid cartilage That is the cricothyroid membrane.

Technique for Performing Open Cricothyrotomy Partner prepares equipment Maintain aseptic technique. Stabilize larynx; make a 1- to 2-cm vertical incision over the cricothyroid membrane.

Technique for Performing Open Cricothyrotomy Insert a 6.0-mm cuffed ET tube or a 6.0 tracheostomy tube into trachea. Inflate the distal cuff. Attach the bag-mask device, and ventilate while your partner auscultates.

Technique for Performing Open Cricothyrotomy Confirm proper tube placement. Ensure bleeding has been controlled. Secure tube and continue to ventilate.

Needle Cricothyrotomy 14- to 16-gauge over-the-needle IV catheter inserted into the trachea High-pressure jet ventilator attached to catheter hub Translaryngeal catheter ventilation

Needle Cricothyrotomy Indications Inability to ventilate by less invasive means Maxillofacial trauma Inability to open mouth Uncontrolled oropharyngeal bleeding Contraindications Severe airway obstruction above catheter insertion High-pressure ventilator leads to barotrauma and pneumothorax If equipment is not immediately available

Needle Cricothyrotomy Advantages Easier than open cricothyrotomy Lower risk of damaging structures Allows for intubation No manipulation of cervical spine Disadvantages Does not provide protection from aspiration Technique requires a specialized, high-pressure jet ventilator

Needle Cricothyrotomy Complications Improper placement can cause severe bleeding. Excessive air leakage can cause subcutaneous emphysema and compression of the trachea. Overinflation of lungs: barotrauma Underinflation of lungs: hypoventilation

Needle Cricothyrotomy Equipment Large-bore IV catheter (14–16 gauge) 10-mL syringe 3 mL of sterile water or saline Oxygen source (50 psi) High-pressure jet ventilator device and oxygen tubing

Technique for Performing Needle Cricothyrotomy Draw up approximately 3 mL of sterile water or saline into a 10-mL syringe. Attach to IV catheter. Place head in neutral position Locate the cricothyroid membrane. Cleanse area if time permits.

Technique for Performing Needle Cricothyrotomy Stabilize the larynx; insert the needle at a 45° angle toward the feet. You should feel a pop as the needle penetrates the membrane. After a pop is felt, insert needle 1 cm farther; aspirate with the syringe.

Technique for Performing Needle Cricothyrotomy Advance catheter over needle until catheter hub is flush with skin Withdraw the needle; dispose of properly. Attach one end of the oxygen tubing to the catheter; other end to the jet ventilator

Technique for Performing Needle Cricothyrotomy Begin ventilations by opening the release valve on the jet ventilator Turn release valve off with chest rise. Secure catheter and continue ventilations.

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