| Mr. Ibrahem/Cricothyrotomy | |
|---|---|
 In cricothyrotomy, the incision or puncture is made through the cricothyroid membrane, between the thyroid and cricoid cartilage. Should be horizontal rather than vertical. | |
| Other names | Cric, crike, thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy, emergency airway puncture, emergency surgical airway |
| Specialty | Emergency medicine |
| Complications | Bleeding, infection, fistula formation[1] |
Cricothyrotomy is a cut through the skin and cricothyroid membrane to establish an airway when other means of ventilating a person, such as intubation and bag valve mask fail.[4] This may include in the setting of excessive bleeding within the mouth or facial trauma.[4]
While the procedure can be done in a number of ways, a common technique is the "scalpel-finger-bougie".[4] The first step is locating the cricothyroid membrane (CTM) between the thyroid and cricoid cartilage.[4] A 4 cm vertical cut is made through the skin.[4] A horizontal cut is made through the CTM.[4] A finger and then a bougie is placed in the hole.[4] A 6.0 ET tube is then placed over the bougie until the cuff just disappears at which point it is inflated.[4]
Signs of success include end-tidal CO2 and chest rise on both sides.[4][1] The ET tube is than secured in place.[4] In those at high risk, set up for a cricothyrotomy may be done before starting intubation.[1] The procedure cannot be carried out in those under the age of 6 to 8 years, though jet ventilation may be done in younger people.[2][3] Cricothyrotomy is easier to perform than a tracheotomy, though this procedure may be performed at a later date.[4][2]
The procedure was first formally carried out in 1909, though did not come into common use until the 1970s.[4] Use has become less common due to other improvements in airway management.[2] The average time to perform the procedure is just over a minute.[1]
References edit
- ^ a b c d e "Surgical Cricothyroidotomy • LITFL Medical Blog • CCC Airway". Life in the Fast Lane • LITFL. 1 January 2019. Retrieved 18 March 2021.
- ^ a b c d e M. Gregory Katos; David Goldenberg (June 2007). "Emergency cricothyrotomy". Operative Techniques in Otolaryngology. 18 (2): 110–114. doi:10.1016/j.otot.2007.05.002. Retrieved 25 July 2010.
- ^ a b "How To Do a Percutaneous Cricothyrotomy - Critical Care Medicine". Merck Manuals Professional Edition. Retrieved 18 March 2021.
- ^ a b c d e f g h i j k l m n McKenna, P; Desai, NM; Morley, EJ (January 2021). "Cricothyrotomy". PMID 30726035.
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