0071643192.pdf

CONTRAINDICATIONS

■ Difficult to perform in patients < 10 years old

PROCEDURE

■ Locate the cricothyroid membrane with nondominant hand.
■ Make a midline longitudinal skin incision at the level of the cricothyroid
membrane.
■ Stabilizing the larynx with thumb and middle finger of nondominant
hand, make an horizontal incision in the cricothyroid membrane.
■ Use the tracheal hook to maintain control of trachea.
■ Bluntly widen the cricothyroid membrane orifice with finger or blunt end
of scalpel/hemostat.
■ Insert the tracheostomy or endotracheal tube.
■ Confirm placement with ETCO 2.

COMPLICATIONS

■ More likely in pediatric population due to lack of laryngeal prominence,
superior larynx, and small cricothyroid membrane
■ Bleeding
■ Airway injury

MANAGEMENT OFAIRWAYOBSTRUCTION

HEIMLICHMANEUVER

INDICATION

■ Complete airway obstruction due to tracheal foreign body

CONTRAINDICATION

■ Breathing/coughing patient with adequate oxygenation

PROCEDURE

■ Child/adult
■ Subdiaphragmatic thrusts
■ Arms wrapped around victim if conscious
■ Infant/small toddler: 5 back blows followed by 5 chest thrusts
■ Direct laryngoscopy with foreign body removal, when available

Ventilation Techniques

NONINVASIVEVENTILATION

Requirements: Patent airway, patient cooperation, and intact respiratory drive

Allows time to treat the cause of respiratory distress, avoid ET intubation and
its associated complications, and ↓length of stay

CONTINUOUSPOSITIVEAIRWAYPRESSURE(CPAP)

■ Provides constant airway pressure to prevent upper airway collapse

■ Need properly fitted mask

■ Reduces work of breathing, increases oxygenation and CO 2 clearance

RESUSCITATION

Surgical cricothyrotomy is

difficult to perform in children

<10 years old. Needle

cricithyrotomy is a better

choice in this age group.

Do not perform the Heimlich

maneuver on a patient who is

breathing or coughing and

appears to have adequate

oxygenation.

Surgical cricothyrotomy:

Longitudinal (vertical) skin

incision.

Horizontal incision through

cricoid membrane.

Abdominal thrusts are

relatively contraindicated in

pregnant patients. Use chest

compressions instead.