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Cricothyroidotomy

  • It can be performed with the patients head in neutral position.
  • Palpate the cricothyroid membrane in the midline, between the thyroid and cricoid cartilages.
  • It is critical to stay precisely in the midline during this procedure to ensure the airway is cannulated appropriately and significant bleeding is avoided.
  • Attach a 14 gauge angicath to a 10 ml syringe
  • While palpating the cricothyroid membrane, insert the angio just below the midpoint of the cricothyroid membrane with the needle angled 45 degrees caudally
  • Rapid aspiration of air into the syringe indicates entry into the tracheal lumen.
  • Withdraw the needle carefully while advancing the plastic catheter into the trachea, taking care not to perforate the posterior wall.
  • Attach the hub of the catheter to an adapter and then to a Y connector which is hooked up to the oxygen supply.
  • Oxygen flow is set at 15 liters/minute.
  • Intermittent ventilation is achieved by occluding the open port of the Y connecter 1 second vs 4 seconds off.
  • This allows about 30-40 minutes of oxygenation

Figure 1.
Needle Cricothyroidotomy. A: Anatomy of cricothyroid area. B: Insertion of a angiocatheter. C: Attach Luer-lock to oxygen source. D: Surgical cricothyroidotomy (very rarely indicated).

Figures illustrating cricothyroidotomy
Source: Advanced Pediatric Life Support Course Text Book

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