0071643192.pdf

RESUSCITATION

A lateral or poorly defined

glow indicates improper

lighted stylet placement.

Needle cricothyrotomy will

provide oxygenation, but

ventilation may be

inadequate.

■ A well-defined glow anteriorly and midline below the larynx indicates

tracheal placement.

■ Advance ET tube.

■ Confirm placement.

An 8-year-old boy is in respiratory arrest after being ejected from a car

during a rollover accident. He has obvious head and face trauma. You are

unable to intubate or BVM ventilate. What should you do next?

This child has a failed airway (“can’t intubate, can’t ventilate”). You should

immediately perform a needle cricothyrotomy to provide oxygenation. While you

prep and initiate the procedure, another provider can attempt to place an LMA

as a rescue maneuver.

NEEDLECRICOTHYROTOMY

Surgical airway of choice in children <10 years old. Allows for oxygenation,

but ventilation is often inadequate.

INDICATIONS

■ Rescue device for oxygenationin failed airway

CONTRAINDICATION

■ Tracheal transection with retraction of the distal end

■ Cricoid or laryngeal damage

PROCEDURE

■ Attach a 12- or 14-gauge needle catheter to a 3-mL syringe.

■ Locate and stabilize the cricoid membrane.

■ Direct the needle catheter inferiorly and insert it (aspirating continuously)

through the cricoid membrane into the trachea.

■ Once in trachea, advance the catheter over the needle.

■ Attach catheter to jet-ventilation system and oxygenate.

■ Deliver 100% O 2 for 1 second, then release for 4 seconds and repeat.

COMPLICATIONS

■ Common

■ Subcutaneous emphysema, catheter kinking/obstruction, coughing if

patient is conscious, CO 2 retention

■ Uncommon but serious

■ Barotrauma, pneumothorax, pneumomediastinum

CRICHOTHYROTOMY

Equipment needed at a minimum: Scalpel, tracheal hook, 5.5 or 6.0 cuffed

endotracheal tube

INDICATIONS

■ Failed airway

Advantages of needle

cricothyrotomy over surgical

cricothyrotomy: Simpler,

faster, less bleeding, fewer

long-term complications, can

be done in patients of all ages!