Needle cricothyrotomy: Difference between revisions
 
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== Indications ==
==Indications==
#Failed airway in adults or children
[[File:F8.png|thumb|External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.]]
#Temporizing measure until definitive airway management
[[File:Cartilages and ligaments of the larynx.png|thumb|The cartilages and ligaments of the larynx seen posteriorly.]]
##Especially useful in children <8 yrs old, whom cricothyrotomy contraindicated
*Failed airway in adults or children
#Used for transtracheal jet ventilation
**Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on source<ref>Roberts, et al.(2014). Roberts and Hedges' clinical procedures in emergency medicine.</ref>)
*Temporizing measure until definitive airway management
**Will provide adequate oxygenation, but will NOT provide adequate ventilation
*Obstruction above the level of the cricothryoid membrane


== Contraindications ==
==Contraindications==
#Tracheal transection
When used as a rescue airway, no absolute contraindications.
#Complete upper airway obstruction


== Equipment ==
*Relative Contraindications
#Provodone iodine
**Inability to identify landmarks
#Sterile drapes, gloves, gown, gauze
**Tracheal transection or severe trauma
#12-14 G angiocath
**Underlying tumor, abscess/infection, or other known abnormality
#3mL syringe x 2
#Adapter to 7-0 ETT
#BVM appropriate for size of pt
##Can also use jet vet ventilation setup in adults
###High flow O2 source, 50 PSI
###O2 tubing
###Valve-3 way stop cock or cut holes in O2 tubing
###Depending on O2 source, calculate time valve must be open for tidal vol
###BVM setup does not allow adequate exhalation in adults


== Procedure ==
==Equipment==
*Povidone iodine
*Sterile drapes, gloves, gown, gauze
*12-14 G angiocath
*3mL syringe x 2
*Adapter to 7-0 ETT or adapter to 3-0 ETT
*BVM appropriate for size of patient
**Can also use jet vet ventilation setup in adults
***High flow O2 source, 50 PSI
***O2 tubing
***Valve-3 way stop cock or cut holes in O2 tubing
***Depending on O2 source, calculate time valve must be open for tidal volume
***BVM setup does not allow adequate exhalation in adults
 
==Procedure==
[[File:Cricothyrotomy.png|thumb|(1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea '''(A) Cricothyrotomy site''' (B) Tracheotomy site]]
#Prep and drape
#Prep and drape
#Locate cricothyroid membrane
#Locate cricothyroid membrane
#Pierce membrane with angiocath directed 30-45 deg caudal
#Pierce membrane with angiocath directed 30-45 deg caudal
##Attach 3mL syringe with saline, aspirate as you enter
#*Attach 3mL syringe with saline, aspirate as you enter
##Advance until air is aspirated in syringe
#*Advance until air is aspirated in syringe
#Advance catheter over needle, hub to skin
#Advance catheter over needle, hub to skin
##Remove needle
#*Remove needle
#Attach 3 mL syringe to catheter
#Attach 3-0 ETT adapter directly to angiocath (best option)
#Attach 7-0 ETT adapter to syringe
#*OR attach 3 mL syringe to catheter, then attach 7-0 ETT adapter to syringe
#*OR attach 10 mL syringe to catheter, then insert actual 7-0 ETT (works best with cut down ETT) into syringe and blow up balloon so that ETT does not move
#Attach BVM to ETT adapter
#Attach BVM to ETT adapter
#Secure system
#Secure system
#Ventilate with BVM or high flow O2 setup
#Ventilate with BVM or high flow O2 setup
#OBTAIN DEFINITIVE AIRWAY
#OBTAIN DEFINITIVE AIRWAY
#*Should be used for < 45 minutes
==Complications==
*Hemorrhage
*Infection
*Tracheal stenosis
*Subcutaneous emphysema
*Posterior tracheal perforation
==See Also==
*[[Intubation]]
*[[Surgical airways]]


== Complications ==
==External Links==
#Hemorrhage
*[https://emcrit.org/emcrit/cricothyrotomy-needle-or-knife/ EMCrit: Needle vs Knife: Part I]
#Infection
#Tracheal stenosis
#Not obtaining definitive airway management


== See Also ==
===Videos===
[[Intubation]]<br />
*EMCrit (0:50) https://www.youtube.com/watch?v=Q0RVlgwC9rs&feature=emb_logo
*EMCrit (0:58) https://www.youtube.com/watch?v=WnTBm5f_ihQ&feature=emb_logo
*Henneman (6:59) https://www.youtube.com/watch?v=bIbl6zgWBjg&feature=emb_logo


[[Cricothyrotomy]]
{{#widget:YouTube|id=a4I0MEwtXFY}}


== Source ==
==References==
Roberts and Hedges
<references/>


[[Category:Airway/Resus]]
[[Category:Critical Care]]
[[Category:ENT]]
[[Category:ENT]]
[[Category:Procedures]]
[[Category:Procedures]]

Latest revision as of 21:30, 17 April 2024

Indications

External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.
The cartilages and ligaments of the larynx seen posteriorly.
  • Failed airway in adults or children
    • Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on source[1])
  • Temporizing measure until definitive airway management
    • Will provide adequate oxygenation, but will NOT provide adequate ventilation
  • Obstruction above the level of the cricothryoid membrane

Contraindications

When used as a rescue airway, no absolute contraindications.

  • Relative Contraindications
    • Inability to identify landmarks
    • Tracheal transection or severe trauma
    • Underlying tumor, abscess/infection, or other known abnormality

Equipment

  • Povidone iodine
  • Sterile drapes, gloves, gown, gauze
  • 12-14 G angiocath
  • 3mL syringe x 2
  • Adapter to 7-0 ETT or adapter to 3-0 ETT
  • BVM appropriate for size of patient
    • Can also use jet vet ventilation setup in adults
      • High flow O2 source, 50 PSI
      • O2 tubing
      • Valve-3 way stop cock or cut holes in O2 tubing
      • Depending on O2 source, calculate time valve must be open for tidal volume
      • BVM setup does not allow adequate exhalation in adults

Procedure

(1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy site (B) Tracheotomy site
  1. Prep and drape
  2. Locate cricothyroid membrane
  3. Pierce membrane with angiocath directed 30-45 deg caudal
    • Attach 3mL syringe with saline, aspirate as you enter
    • Advance until air is aspirated in syringe
  4. Advance catheter over needle, hub to skin
    • Remove needle
  5. Attach 3-0 ETT adapter directly to angiocath (best option)
    • OR attach 3 mL syringe to catheter, then attach 7-0 ETT adapter to syringe
    • OR attach 10 mL syringe to catheter, then insert actual 7-0 ETT (works best with cut down ETT) into syringe and blow up balloon so that ETT does not move
  6. Attach BVM to ETT adapter
  7. Secure system
  8. Ventilate with BVM or high flow O2 setup
  9. OBTAIN DEFINITIVE AIRWAY
    • Should be used for < 45 minutes

Complications

  • Hemorrhage
  • Infection
  • Tracheal stenosis
  • Subcutaneous emphysema
  • Posterior tracheal perforation

See Also

External Links

Videos

{{#widget:YouTube|id=a4I0MEwtXFY}}

References

  1. ↑ Roberts, et al.(2014). Roberts and Hedges' clinical procedures in emergency medicine.
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