Emergency Medicine

CRICOTHYROTOMY

470 Practical Procedures

(iv) Remove the bougie, inflate the cuff and connect the tube to an

Ambu or Laerdal bag and oxygen supply.

3 Needle cricothyroidotomy

(i) Insert a large-bore 14-gauge i.v. cannula with syringe at 45°

caudally through the cricothyroid membrane, and aspirate air to

confirm correct placement.

(ii) Remove the needle and attach the cannula to wall oxygen at

15 L/min using a Y-connector.

(iii) Insufflate oxygen by intermittent occlusion of the open end of the

Y-connector for 1 s in every 5.

Sternomastoid

Thyroid

Trachea

Thyroid ca

Cricothyro

Cricoid ca

Sternomastoid Thyroid

cartilage

Thyroid

Cricothyroid me

Figure 18.1 Cricothyrotomy.
The anatomical relationships of the cricothyroid membrane (a) anteroposterior view, and
(b) oblique lateral view.

Cricothyroid membrane

(b)

(a)

Cricothyroid

membrane

Cricoid

cartilage

Trachea