Needle Cricothyroidotomy

King Saud University College of Nursing

Needle cricothyroidoto my Hatem Alsrour

A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or emergency airway puncture) is an emergency incision through the skin and cricothyroid membran to secure a patient's airway during certain emergency situations, such as an airway obstructed by a foreign object or swelling, a patient who is not able to breathe adequately on their own, or in cases of major facial truma which prevent the insertion of an airway through the mouth. A cricothyrotomy is usually performed by emergency physicians , trauma surgeons, or paramedics as a last resort when control of the airway by usual means (an endotrachial tube through the mouth) have failed or are not feasible. This technique is considered easier and faster than a trachiostomy, but is only used when oral or nasal intubation is not possible. This procedure does not require manipulation of the cervical spine. However, it does require special training and authorization from local medical direction prior to being performed, depending on local medical protocol. There are three techniques: Needle Intubation (with purpose-built kits) Surgical

Procedure: In a needle cricothyroidotomy, a syringe with a needle attached is used to make a puncture hole through the cricothyroid membrane that overlies the trachea. After the needle has reached the trachea, a catheter is passed over the needle into the windpipe and attached to a bag-valve device.

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Indications:

Intubation is not possible via the oral or nasal route Need to avoid neck manipulation (e.g. basal skull/cervical spine injury or fracture) Severe maxillofacial trauma Severe oropharyngeal/tracheobronchial haemorrhage Foreign body in upper airway Lack of equipment for endotracheal intubation Technical failure of intubation  Burns in or around the mouth

Contraindications: Inability to identify landmarks

(cricothyroid membran) Underlying anatomical abnormality (tumer) Tracheal transection Acute laryngeal disease due to infection or trauma Laryngeal fracture

Risks:

The risks of a needle cricothyroidotomy include:

external scar from needle puncture bleeding accidental perforation of the esophagus hypercarbia (overly high levels of carbon dioxide in the blood)