1. Surgical and Nonsurgical Cricothyrotomy
EMS 352
DR AQEELA BANO

2. Surgical and Nonsurgical Cricothyrotomy
Used when conventional techniques fail
Be familiar with:
Anatomy of the anterior aspect of the neck
Important blood vessels in area

3. Open Cricothyrotomy Involves:
Incising the cricothyroid membrane
Inserting an ET or tracheostomy tube directly into the subglottic area of the trachea
Cricothyroid membrane is ideal for surgical opening into the trachea

4. Open Cricothyrotomy Several types: Open (surgical) cricothyrotomy
Modified cricothyrotomy (Seldinger technique)
Device that functions as an introducer and an airway
Courtesy of Cook Medical

5. Open Cricothyrotomy Indications
Patent airway cannot be secured with conventional means
Severe foreign body obstructions
Swelling of airway
Maxillofacial trauma
Inability to open mouth

6. Open Cricothyrotomy Contraindications
Ability to secure a patent airway
Inability to identify anatomic landmarks
Crushing injuries to the larynx and tracheal transection
Underlying anatomic abnormalities
Age younger than 8 years

7. Open Cricothyrotomy Advantages Disadvantages Can be performed quickly
Do not need to manipulate cervical spine
Disadvantages
Difficult to perform in children and patients with short, muscular, or fat necks
More difficult than needle cricothyrotomy

8. Open Cricothyrotomy Complications
Severe bleeding from laceration of the external jugular vein.
Risks of perforating the esophagus and damaging the laryngeal nerves
Taking too long will result in hypoxia
Subcutaneous emphysema from tube misplacement

9. Open Cricothyrotomy Equipment
If a commercial kit is not available, prepare:
Scalpel
ET or tracheostomy tube
Commercial device (or tape) to secure tube
Curved hemostats
Suction apparatus
Sterile gauze pads
Bag-mask device attached to 100% oxygen

10. Technique for Performing Open Cricothyrotomy
Proceed rapidly yet cautiously
Palpate for V notch of thyroid cartilage
Slide index finger into depression between thyroid and cricoid cartilage
That is the cricothyroid membrane.

11. Technique for Performing Open Cricothyrotomy
Partner prepares equipment
Maintain aseptic technique.
Stabilize larynx; make a 1- to 2-cm vertical incision over the cricothyroid membrane.

12. Technique for Performing Open Cricothyrotomy
Insert a 6.0-mm cuffed ET tube or a 6.0 tracheostomy tube into trachea.
Inflate the distal cuff.
Attach the bag-mask device, and ventilate while your partner auscultates.

13. Technique for Performing Open Cricothyrotomy
Confirm proper tube placement.
Ensure bleeding has been controlled.
Secure tube and continue to ventilate.

14. Needle Cricothyrotomy
14- to 16-gauge over-the-needle IV catheter inserted into the trachea
High-pressure jet ventilator attached to catheter hub
Translaryngeal catheter ventilation

15. Needle Cricothyrotomy
Indications
Inability to ventilate by less invasive means
Maxillofacial trauma
Inability to open mouth
Uncontrolled oropharyngeal bleeding
Contraindications
Severe airway obstruction above catheter insertion
High-pressure ventilator leads to barotrauma and pneumothorax
If equipment is not immediately available

16. Needle Cricothyrotomy
Advantages
Easier than open cricothyrotomy
Lower risk of damaging structures
Allows for intubation
No manipulation of cervical spine
Disadvantages
Does not provide protection from aspiration
Technique requires a specialized, high-pressure jet ventilator

17. Needle Cricothyrotomy
Complications
Improper placement can cause severe bleeding.
Excessive air leakage can cause subcutaneous emphysema and compression of the trachea.
Overinflation of lungs: barotrauma
Underinflation of lungs: hypoventilation

18. Needle Cricothyrotomy Equipment
Large-bore IV catheter (14–16 gauge)
10-mL syringe
3 mL of sterile water or saline
Oxygen source (50 psi)
High-pressure jet ventilator device and oxygen tubing

19. Technique for Performing Needle Cricothyrotomy
Draw up approximately 3 mL of sterile water or saline into a 10-mL syringe.
Attach to IV catheter.
Place head in neutral position
Locate the cricothyroid membrane.
Cleanse area if time permits.

20. Technique for Performing Needle Cricothyrotomy
Stabilize the larynx; insert the needle at a 45° angle toward the feet.
You should feel a pop as the needle penetrates the membrane.
After a pop is felt, insert needle 1 cm farther; aspirate with the syringe.

21. Technique for Performing Needle Cricothyrotomy
Advance catheter over needle until catheter hub is flush with skin
Withdraw the needle; dispose of properly.
Attach one end of the oxygen tubing to the catheter; other end to the jet ventilator

22. Technique for Performing Needle Cricothyrotomy
Begin ventilations by opening the release valve on the jet ventilator
Turn release valve off with chest rise.
Secure catheter and continue ventilations.

23. ANY QUESTIONS?????????????????