Name: ACA- Hung 4e- Invasive Infraglottic Airways

Description: ACA- Hung 4e- Invasive Infraglottic Airways

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Duration: T00H03M58S

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Upload Date: 2023-11-24T00:00:00.0000000

Transcript: Language: EN.
Segment:1 Introduction .
Cricothyrotomy is a lifesaving procedure in patients when tracheal intubation and oxygenation using a bag mask or an extraglottic device has failed.
Segment:2 Percutaneous Dilational Cricothyrotomy.
Segment:3 Equipment .
If a Melker percutaneous cricothyrotomy kit is not available, the following equipment is required to perform a percutaneous dilational cricothyrotomy-- a number 11 scalpel blade, a 5 cc syringe, an 18-gauge needle, a guide wire, a dilator, and a cuffed airway catheter.
Segment:4 Technique .
With the neck well exposed, the cricothyroid space is identified. The cricothyroid space is then punctured by an 18-gauge needle attached to a 5 milliliter syringe with 2 to 3 milliliters of saline or a local anesthetic. The needle syringe combination is directed in a caudad direction. The placement of the needle into the trachea is confirmed by aspiration of air bubbles in the syringe.
To confirm that the catheter remains inside the trachea, aspiration of air should be repeated through the catheter after removal of the needle. A guide wire is then inserted through the catheter caudally. And the catheter is subsequently removed. A generous incision through the skin and cricothyroid membrane along the guide wire is made with the scalpel. The tracheal cannula preloaded onto the dilator is then advanced as a single unit over the wire and into the trachea.
The dilator and guide wire are removed together. Proper tube placement is then confirmed by end-tidal CO2 and by auscultation.
Segment:5 Open Cricothyrotomy.
Segment:6 Equipment.
For open cricothyrotomy, the instruments required include a scalpel with a number 11 blade, a tracheal hook, a Trousseau dilator, and a small cuffed tracheotomy tube.
Segment:7 Technique.
With the patient positioned and landmarks identified, the following steps are recommended. A right-handed operator stands on the patient's right and gently grasps the thyroid cartilage with the left hand, locating the cricothyroid space with the tip of the index finger from above. A 4 centimeter vertical midline skin incision is made. The index finger is reinserted through the incision to locate the cricothyroid space.
A transverse incision of the cricothyroid membrane is performed at the superior border of the cricoid cartilage. And the tracheal hook is inserted under the inferior border of the thyroid cartilage. The tracheal hook is grasped with the non-dominant hand. The index finger is inserted through the cricothyroid membrane incision to dilate it and to provide a path for the Trousseau dilator.
A number 5 cuffed tracheotomy tube is then inserted through the cricothyroid membrane caudally with a rotating motion. Following the placement of the tube, the dilator and hook are removed. Proper tube placement is then confirmed by end-tidal CO2 and by auscultation.
Segment:8 Summary .
This narrative describes both the percutaneous dilational technique and the open cricothyrotomy technique.
With the proper preparation, these techniques can be performed relatively easily. Commercial kits are now available that contain the equipment for both techniques. This kit should be available in all areas where airway management is undertaken.

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