patient positioning

extend neck

landmarks

Cricothyroid membrane

Equipment:

Scalpel (number 10 blade)
Bougie
Tube (cuffed 6.0mm ID)

Laryngeal handshake to identify cricothyroid membrane

Palpable cricothyroid membrane

Transverse stab incision through cricothyroid membrane
Turn blade through 90° (sharp edge caudally)
Slide coude tip of bougie along blade into trachea
Railroad lubricated 6.0mm cuffed tracheal tube into trachea
Ventilate, inflate cuff and confirm position with capnography
Secure tube

Impalpable cricothyroid membrane

Make an 8-10cm vertical skin incision, caudad to cephalad
Use blunt dissection with fingers of both hands to separate tissues Identify and stabilise the larynx
Proceed with technique for palpable cricothyroid membrane as above

after e-FONA

• Postpone surgery unless immediately life threatening
• Urgent surgical review of cricothyroidotomy site
• Document and follow up as in main flow chart

Important note for needle cric

this is in the DAS algorithm for children
this is also an evidence light zone, understandably
oxygenation will need a pressure limiting device at lowest delivery pressure or 4Bar O2 source and Y connector
- wait for full expiration before next inflation

#airway #anatomy-head-neck

sources/links

https://litfl.com/surgical-cricothyroidotomy/ + https://litfl.com/cannula-cricothyroidotomy/
https://www.instantanatomy.net/headneck/areas/lytracheostomyandcricothyroidotomy.html
https://das.uk.com/guidelines/paediatric-difficult-airway-guidelines/

Cricothyroidotomy