CRICOTHYROTOMY

Practical Procedures 469

4 Drug reaction such as anaphyla xis.

5 Aspiration.

CRICOTHYROTOMY

INDICATIONS

1 ‘Can’t intubate, can’t ventilate’.

2 Trachea l intubation considered impossible, or unacceptably high risk:
(i) Severe maxillofacial trauma.
(ii) Massive oedema of the throat tissues (e.g. angioedema, airway
burns).
(iii) Severe trismus or clenched teeth; masseter spasm after
suxamethonium.
(iv) Foreign body/tumour blocking upper airway.

CONTRAINDICATIONS

1 Children <12 years of age (use needle cricothyrotomy only).

2 Acute or pre-existing laryngeal pathology (e.g. laryngeal fracture).

3 Inability to identify landmarks (e.g. surgical emphysema/haemorrhage/
inflammation).

TECHNIQUE

1 Extend the patient’s neck and identify the cricothyroid membrane between
the lower border of the thyroid cartilage and the upper border of the cricoid
cartilage (see Fig. 18.1).

2 Surgical cricothyroidotomy
(i) Make a transverse incision through the skin and cricothyroid
membrane with a scalpel blade.
(ii) Rotate the scalpel blade and pass a bougie caudally through the
hole into the trachea.
(iii) Insert (railroad) a 6 mm endotracheal tube (or small
tracheostomy tube) over the bougie and into the trachea.

Warning: never attempt rapid sequence induction (RSI) unless you have

been trained. Use a bag-valve mask technique instead, while waiting for

help.

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