Name: 01 Cricothyroidotomy

Description: 01 Cricothyroidotomy

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Upload Date: 2022-03-03T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
In this video, we will discuss the proper technique to perform a cricothyroidotomy.
Segment:1 Objectives.
First, we will begin by reviewing the anatomy, followed by the instruments required and proper positioning, the exposure and technique, and, finally, tips and pitfalls for this procedure.
Segment:2 Anatomy.
The cricothyroid membrane lies between the cricoid cartilage and the thyroid cartilage in the midline. It is a thin membrane, approximately one centimeter wide, which is relatively superficial and easily accessed, making it ideal for an emergent airway creation when intubation is not possible.
Segment:3 Instruments and Positioning.
The patient is positioned in the supine position with the neck in a neutral position. If the cervical spine is cleared, the neck may be slightly extended either manually, or with a support, in order to facilitate exposure. In a truly emergent situation, the only instruments required are a scalpel and an airway, either a #6 endotracheal tube, or tracheostomy. If available, a tracheal hook, Senn retractor, or one of the commercially available cricothyroidotomy kits can be helpful.
With the patient positioned, one must first identify the cricothyroid membrane, just below the thyroid cartilage. In some circumstances, secondary to injury or body habitus, it may not be able to be palpated. In this case, one should use the four finger technique, which involves placing the tip of the small finger in the sternal notch with the fingers opposed and the tip of the index finger should approximate the cricothyroid membrane. A firm grasp is maintained on the thyroid cartilage to stabilize the airway and the midline, and, using a scalpel, a vertical incision is made in the skin.
A vertical incision is preferred as it is extensile and avoids unnecessary bleeding from the anterior jugular veins, which lie lateral to the incision. The incision is carried down through the subcutaneous fat and the platysma. The cricothyroid membrane can now be palpated easily. The scalpel is then used to incise the cricothyroid membrane in a transverse type fashion.
A tracheal hook is then used to stabilize the airway, and the cricothyroidotomy is dilated using a Kelly clamp. At this point, a #6 tracheostomy, or endotracheal tube, is then inserted into the airway, and the cuff inflated.
Positioning is then confirmed using a colorimetric end-tidal CO2 detector, and the airway may be secured at the level of the skin using a suture.
Segment:4 Tips and Pitfalls.
Points to remember during this procedure include usage of the four finger technique to estimate the location of the cricothyroid membrane. Also, a vertical skin incision is extensile and minimizes risk of inadvertent bleeding.
Maintenance of a firm grasp on the thyroid cartilage during the procedure will help immobilize the airway. And in the pediatric population, age less than eight years, is a relative contraindication of cricothyroitomy and one should consider jet insufflation as an alternative. Thank you.

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