Cricothroidotomy
Cricothroidotomy
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Cricothroidotomy is an emergency medial procedure in which an incision is
made through skin and cricothyroid membrane to obtain the airway when other
procedures e.g. orotracheal,endotracheal and laryngeal mask airway are not
effective or contraindicated.Cricothyroidotomy is life-saving in many
conditions so healthcare providers must know this procedure.It is also known
with other names such as cricothyrotomy, throcricotomy, coniotomy and emergency
airway puncture.
INDICATIONS
Cricothyrotomy is mostly the last option for obtaining an airway but it is
indicated in the following conditions:
* Oral, nasal and pharyngeal hemorrhage
* Facial trauma
* Laryngospasm
* Emesis
* Cervical spine trauma
* Oropharyngeal edema
* Obstruction of airway by foreign body
CONTRAINDICATIONS
Cricothrotomy cannot be performed in children below 10 years at any condition.Some
use 12 years as the cutoff age.It is also not performed when person is
suffering with acute laryngeal infection.It should not be done when the anatomy
of the cricothyroid membrane is altered by pathology such as tumors.
EQUIPMENTS
You should have following equipments to perform the cricothyrotomy:
* Sterile gloves
* Antiseptic solution (alcohol)
* Local anesthetic
* Scalpel
* Scalpel handle
* Endotracheal tube
* 10 cc syringe
* Stylet
* Water soluble lubrication
* Sterile dressing
* Tape
* Sthethoscope
PROCEDURE
1- Place the patient in supine position.
2-Locate the thyroid cartilage and cricothyroid membrane.
3-Clean the skin with alcohol and let it dry.
4-Anesthesize the area by local anesthetic.
5-Stabilize the thyroid cartilage with non dominant hand and make a
vertical incision of about 2.5 cm over the cricothyroid membrane.
6-Check the cricothyroid membrane and make a horizontal incision through
it.Remember not to go more than 0.5 inch deep to avoid the oesophagus
peroration.
7-Open the incision by using inverted scalpel handle.
8-Insert the endotracheal tube (8 mm) down into the trachea.
9-Inflate the tube cuff with air by using the 10 cc syringe.
10-Auscultate over lungs and stomach and check the chest movements to
confirm the position of endotracheal tube.
11- Fix the tube by using tape.
12-Apply sterile dressing.
COMPLICATIONS
Complications of cricothyrotomy are very rare if it is performed by an
experienced person.Following complications may occur:
* Hemorrhage
* Oesophageal perforation
* Tracheo-oesophageal fistula
* Subcutaneous emphysema
* Thyrohyoid membrane incision
* Dysphonia
PATIENTS EDUCATION
You will need to inform your patient if he is conscious that it is a very short procedure and will take less than 5 minutes.Explain the whole procedure and its complications to your patient.
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