Emergency Medicine at HCMC
Procedure Lab > Cricothyrotomy

INDICATIONS

a)	Failure of more conservation surgical and non-surgical techniques
b)	Severe facial injury
c)	Upper airway obstruction

TECHNIQUE

a)	Check tracheostomy tube balloon
b)	Identify cricothyroid membrane
c)	Prep neck
d)	Make vertical 1 inch incision over membrane
e)	Palpate cricothyroid membrane again
f)	Stab scalpel blade through the membrane with the blade oriented horizontally. Leave the blade in place until the next instrument is introduced into the trachea
g)	Slide the scissors tip into the tracheal lumen alongside the scalpel blade. Once the scissors is in place, the scalpel is removed and the scissors spread
h)	Insert the tip of a Trousseau tracheal dilator into the lumen through the existing hole
i)	Spread the dilator in the opposite direction of the scissors
j)	Remove the scissors and orient the dilator in the horizontal plane
k)	Insert a tracheal hook through incision and hook trachea at inferior aspect of incision of the membrane
l)	Insert a #4 trach tube with the obturator in place into the lumen with gentle rotary pressure
m)	Remove the obturator and insert the sleeve
n)	Inflate cuff, ventilate patient, listen to both lungs
o)	Remove Trousseau dilator, secure tube with twill tape

Figure 7-5. Mayo scissors are used to enlarge the hole in a transverse plane	Figure 7-6. When the tube is in place, the dilator is withdrawn.

For more information contact Richard O. Gray MD.

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Manual last modified: Wednesday May 07, 2003.