Cricothyrotomy

Overview
A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or emergency airway puncture) is an emergency incision through the skin and cricothyroid membrane to secure a patient's airway during certain emergency situations, such as an airway obstructed by a foreign object or swelling, a patient who is not able to breathe adequately on their own, or in cases of major facial trauma which prevent an airway through the mouth. A cricothyrotomy is usually performed by emergency physicians, trauma surgeons, or paramedics as a last resort when control of the airway by usual means (an endotracheal tube through the mouth) have failed or are not feasible. This technique is considered easier and faster than a tracheostomy, but is only used when oral or nasual intubation is not possible in the patient. This procedure does not require manipulation of the cervical spine. However, it does require special training and authorization from local medical direction prior to being performed, dependending on local medical protocols.

Indications

 * Severe facial or nasal injuries (that do not allow oral or nasal intubation)
 * Massive midfacial trauma
 * Possible spinal trauma preventing adequate ventilation
 * Anaphylaxis
 * Chemical inhalating injuries

Contraindications

 * Inability to identify landmarks (cricothyroid membrane)
 * Underlying anatomical abnormality (tumor)
 * Tracheal transection
 * Acute laryngeal disease by infection or trauma
 * Small children under 10 years old (a 12-14 gauge catheter over the needle may be safer)

Summarized Technique

 * 1) With a scalpel, create a 2 cm horizontal incision through the cricothyroid membrane
 * 2) Open the hole by rotating the scapel 90 degrees or by using a clamp
 * 3) Insert a size 6 or 7 Endotracheal tube or tracheostomy tube
 * 4) Inflate the cuff and secure the tube
 * 5) Provide venilation via a Bag-Valve device with the highest available concentration of oxygen
 * 6) Determine if ventilation was successful (bilateral ausculation and observing chest rise and fall)

No attempt should be made to remove the Endotracheal tube in a prehospital setting.