Prodcedure for Cricothyrotomy?

Question

Can anyone gove me a step by step outline of the procedure for a Cricotyrotomy? Thank you!

Answer 1

It has been our practice to have a physician adept at emergency cricothyrotomy, often the trauma team leader, apply cricoid pressure with his gloved left hand from the right side of the table when orotracheal intubation is performed by another member of the team. (Fig. 1) This position at the patient's right side is ideal to observe the orotracheal intubation and the pulse oximeter and to provide leadership and control of the trauma resuscitation area while the personnel at the head of the bed are fully focused on intubation. Difficulties in placing the orotracheal tube can be identified early, and the physical landmarks of the cricoid and thyroid cartilages can be identified from this position (Fig. 2) should emergency cricothyrotomy become necessary.

When the decision to perform cricothyrotomy is made, the left hand becomes "fixed" and will not move until the procedure is completed and the airway controlled. After a quick application of topical antiseptic, a No. 15 scalpel is used to make a longitudinal midline incision approximately 1- to 1.5-cm long directly over the cricoid and thyroid cartilages. (Fig. 3) The incision is meant to be full thickness, which is cutting through the skin and subcutaneous tissues down to the cartilages. This is ideally accomplished in a single swipe. The slight notching, which may occur from the scalpel on the cartilages, is entirely acceptable. The fingers of the stabilizing left hand can now apply a slight increase in downward pressure, which will help draw the skin edges apart (Fig. 4) and allow visualization of the cricothyroid membrane (Fig. 5).

The scalpel is then used to make a transverse stab incision through the membrane into the airway. The handle of the scalpel is next introduced into this membrane opening and rotated 90[degrees] or the scalpel can be used to incise the membranes in the sagittal plane. Laying the scalpel aside, a 5.0, 5.5, or 6.0 endotracheal tube is introduced into the trachea with the bevel of the tube pointed caudally to a level of approximately 1 cm above the endotracheal balloon, which is then inflated (Fig. 6). The endotracheal tube is secured with umbilical tape around the neck (Fig. 7) and can be passed through the anterior opening of the rigid cervical collar if necessary.

Answer 2

Simply stick a large needle into the larynx in the cricoid cartilage. I have done this primarily in children.

Answer 3

This is not dissimilar to a Tracheotomy and is concerned with restoring an airway through collapsed thyroid cartilage.

Check out this link: http://www.nda.ox.ac.uk/wfsa/html/u06/u06_b01.htm