Needle Needle cricothyroidotocricothyroidoto

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Hatem AlsrourHatem Alsrour

King Saud UniversityCollege of Nursing

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:Procedure:

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

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Indications:Indications: Intubation is not possible via the oral or Intubation is not possible via the oral or

nasal route nasal route Need to avoid neck manipulation (e.g. Need to avoid neck manipulation (e.g.

basal skull/cervical spine injury or fracture) basal skull/cervical spine injury or fracture) Severe maxillofacial trauma Severe maxillofacial trauma Severe oropharyngeal/tracheobronchial Severe oropharyngeal/tracheobronchial

haemorrhage haemorrhage Foreign body in upper airway Foreign body in upper airway Lack of equipment for endotracheal Lack of equipment for endotracheal

intubation intubation Technical failure of intubationTechnical failure of intubation Burns in or around the mouthBurns in or around the mouthSevere trismus /clenched teethSevere trismus /clenched teeth

Contraindications:Contraindications: Inability to identify landmarks Inability to identify landmarks

(cricothyroid membran) (cricothyroid membran) Underlying anatomical Underlying anatomical

abnormality (tumer) abnormality (tumer) Tracheal transectionTracheal transectionAcute laryngeal disease due to Acute laryngeal disease due to

infection or traumainfection or traumaLaryngeal fractureLaryngeal fracture

Risks:Risks:The risks of a needle cricothyroidotomy include:The risks of a needle cricothyroidotomy include:

external scar from needle puncture external scar from needle puncture

bleeding bleeding

accidental perforation of the esophagus accidental perforation of the esophagus

hypercarbia (overly high levels of carbon hypercarbia (overly high levels of carbon dioxide in the blood) dioxide in the blood)