Needle cricothyrotomy: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Indications== | ==Indications== | ||
[[File:F8.png|thumb|External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.]] | |||
[[File:Cartilages and ligaments of the larynx.png|thumb|The cartilages and ligaments of the larynx seen posteriorly.]] | |||
*Failed airway in adults or children | *Failed airway in adults or children | ||
**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>) | **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>) | ||
Latest revision as of 21:30, 17 April 2024
Indications
- 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
- Can also use jet vet ventilation setup in adults
Procedure
- Prep and drape
- Locate cricothyroid membrane
- 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
- Advance catheter over needle, hub to skin
- Remove needle
- 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
- Attach BVM to ETT adapter
- Secure system
- Ventilate with BVM or high flow O2 setup
- OBTAIN DEFINITIVE AIRWAY
- Should be used for < 45 minutes
Complications
- Hemorrhage
- Infection
- Tracheal stenosis
- Subcutaneous emphysema
- Posterior tracheal perforation
See Also
External Links
Videos
- 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
{{#widget:YouTube|id=a4I0MEwtXFY}}
References
- ↑ Roberts, et al.(2014). Roberts and Hedges' clinical procedures in emergency medicine.