Knowing when to perform cricothyrotomy
Cricothyrotomy is the way to definitively secure the airway of a dying patient (who can't be intubated or ventilated) by cutting a hole through the neck and placing a breathing tube directly into the bronchus.
Indications for cricothyrotomy
There are four indications for the cricothyrotomy procedure:
- Upper airway obstruction
- Laryngeal spasm
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Contraindications for cricothyrotomy
There are three important contraindications for the cricothyrotomy procedure:
- There is an alternative and less invasive way to secure the airway.
- Your patient is younger than eight years old (underdeveloped cricothyroid membrane).
- The obstruction is below the cricothyroid membrane.
Consent for cricothyrotomy
Consent is not possible for cricothyrotomy unless you anticipate a difficult airway before a patient is paralyzed for intubation.
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- Hill, C, Reardon, R, Joing, S, et al. 2010. Cricothyrotomy technique using gum elastic bougie is faster than standard technique: a study of emergency medicine residents and medical students in an animal lab. Acad Emerg Med. 17: 666–669. PMID: 20491685
- MacIntyre, A, Markarian, MK, Carrison, D, et al. 2007. Three-step emergency cricothyroidotomy. Mil Med. 172: 1228–1230. PMID: 18274018
- Quick, JA, MacIntyre, AD, and Barnes, SL. 2014. Emergent surgical airway: comparison of the three-step method and conventional cricothyroidotomy utilizing high-fidelity simulation. J Emerg Med. 46: 304–307. PMID: 24188608