Surgical cricothyrotomy - Revision history

Danbot: Strip excess bold

2026-03-22T09:28:24Z

Strip excess bold

← Revisión anterior		Revisión del 09:28 22 mar 2026
Línea 53:		Línea 53:

	===Standard Technique:===		===Standard Technique:===
	*~~'''~~Identify the Landmarks~~'''~~		*Identify the Landmarks
	**Starting at the Sternal Notch, palpate superiorly until the Laryngeal Prominence is felt. The Cricothyroid Membrane will be approximately one fingerbreadth below this.		**Starting at the Sternal Notch, palpate superiorly until the Laryngeal Prominence is felt. The Cricothyroid Membrane will be approximately one fingerbreadth below this.
	**If not palpable with the prior method, place four fingers longitudinally across the neck with the 5th finger on the Sternal Notch. The Cricothyroid Membrane will be below your Index finger.		**If not palpable with the prior method, place four fingers longitudinally across the neck with the 5th finger on the Sternal Notch. The Cricothyroid Membrane will be below your Index finger.
	*~~'''~~Prepare the Neck~~'''~~		*Prepare the Neck
	**Clean the neck with antiseptic. If time allows, infiltrate the skin and soft tissue with Lidocaine.		**Clean the neck with antiseptic. If time allows, infiltrate the skin and soft tissue with Lidocaine.
	*~~'''~~Stabilize the Larynx~~'''~~		*Stabilize the Larynx
	**Note: This is ESSENTIAL to success.		**Note: This is ESSENTIAL to success.
	**With the thumb and middle finger of the non-dominant hand, grip the posterolateral aspects of the Larynx, while leaving your index finger free to re-palpate the Cricothyroid membrane at any time.		**With the thumb and middle finger of the non-dominant hand, grip the posterolateral aspects of the Larynx, while leaving your index finger free to re-palpate the Cricothyroid membrane at any time.
	*~~'''~~Incise the Skin~~'''~~		*Incise the Skin
	**With your dominant hand, make a 3.5 cm midline VERTICAL incision over the membrane.		**With your dominant hand, make a 3.5 cm midline VERTICAL incision over the membrane.
	*~~'''~~Re-identify the Membrane~~'''~~		*Re-identify the Membrane
	**Use the non-dominant index finger to again relocate the membrane.		**Use the non-dominant index finger to again relocate the membrane.
	*~~'''~~Incise the Membrane~~'''~~		*Incise the Membrane
	**Make a 1 cm HORIZONTAL incision on the lower edge of the membrane.		**Make a 1 cm HORIZONTAL incision on the lower edge of the membrane.
	**Note: The Cricothyroid vessels lie on the superior edge of the membrane. Making a lower incision helps avoid these vessels.		**Note: The Cricothyroid vessels lie on the superior edge of the membrane. Making a lower incision helps avoid these vessels.
	**Aim the scalpel caudally to avoid injuring the vocal cords.		**Aim the scalpel caudally to avoid injuring the vocal cords.
	*~~'''~~Once you have made the incision, slide the index finger of your non-dominant hand into the incision so as to not lose the opening.~~'''~~		*Once you have made the incision, slide the index finger of your non-dominant hand into the incision so as to not lose the opening.
	*~~'''~~Insert the Tracheal Hook~~'''~~		*Insert the Tracheal Hook
	**With your dominant hand, insert the hook TRANSVERSLY. Then, rotate it 90 degrees, so that the hook is oriented cephalad and lift the Larynx upward and cephalad. The hook may now be switched to your non-dominant hand or held by an assistant (preferable).		**With your dominant hand, insert the hook TRANSVERSLY. Then, rotate it 90 degrees, so that the hook is oriented cephalad and lift the Larynx upward and cephalad. The hook may now be switched to your non-dominant hand or held by an assistant (preferable).
	*~~'''~~Insert the Trousseau Dilator~~'''~~		*Insert the Trousseau Dilator
	**With your dominant hand, insert the dilator into the incision and GENTLY enlarge the incision in a vertical direction.		**With your dominant hand, insert the dilator into the incision and GENTLY enlarge the incision in a vertical direction.
	*~~'''~~Remove the dilator place the tracheostomy (or endotracheal) tube over your finger and into the opening.~~'''~~		*Remove the dilator place the tracheostomy (or endotracheal) tube over your finger and into the opening.
	**Note: A gum elastic bougie may be used in place of the above tubes.		**Note: A gum elastic bougie may be used in place of the above tubes.
	*~~'''~~Inflate the cuff and confirm placement.~~'''~~		*Inflate the cuff and confirm placement.

	===Four-Step Technique:===		===Four-Step Technique:===

Rossdonaldson1: /* Contraindications */

2024-04-17T21:35:01Z

Contraindications

← Revisión anterior		Revisión del 21:35 17 abr 2024
Línea 11:		Línea 11:

	==Contraindications==		==Contraindications==
	*No absolute contraindications in adults<ref ~~name=Roberts and Hedges' Clinical Procedures in Emergency Medicine~~>In Roberts, J. R., In Custalow, C. B., In Thomsen, T. W., & In Hedges, J. R. (2014). Roberts and Hedges' clinical procedures in emergency medicine.</ref>		*No absolute contraindications in adults<ref>In Roberts, J. R., In Custalow, C. B., In Thomsen, T. W., & In Hedges, J. R. (2014). Roberts and Hedges' clinical procedures in emergency medicine.</ref>
	*In infants and young children, [[Needle Cricothyrotomy]] may be preferred		*In infants and young children, [[Needle Cricothyrotomy]] may be preferred
	**Cutoff age is debated		**Cutoff age is debated
	***Young as 5 in some sources<ref ~~name=Textbook of Pediatric Emergency Procedures~~>King, C., Henretig, F.M. (2008). Textbook of Pediatric Emergency Procedures.</ref>		***Young as 5 in some sources<ref>King, C., Henretig, F.M. (2008). Textbook of Pediatric Emergency Procedures.</ref>
	***10 or 12 years of age in other		***10 or 12 years of age in other

Rossdonaldson1 at 21:31, 17 April 2024

2024-04-17T21:31:03Z

← Revisión anterior		Revisión del 21:31 17 abr 2024
Línea 2:		Línea 2:
	[[File:F8.png\|thumb\|External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.]]		[[File:F8.png\|thumb\|External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.]]
	[[File:Cartilages and ligaments of the larynx.png\|thumb\|The cartilages and ligaments of the larynx seen posteriorly.]]		[[File:Cartilages and ligaments of the larynx.png\|thumb\|The cartilages and ligaments of the larynx seen posteriorly.]]
	~~[[File:Ant Neck Cric.png\|thumb\|Anterior neck anatomy with site of initial surgical cricothyrotomy incision (red line).]]~~
	*'Can't intubate, can't ventilate'		*'Can't intubate, can't ventilate'
	**Need to secure an airway and cannot do so by non-surgical means		**Need to secure an airway and cannot do so by non-surgical means
Línea 10:		Línea 9:
	**Severe facial trauma or burns with distorted anatomy		**Severe facial trauma or burns with distorted anatomy
	**Failed airway		**Failed airway

	~~[[File:Larynx external Cricothyrotomy.gif\|thumb\|Landmarks for Cricothyrotomy]]~~

	==Contraindications==		==Contraindications==
Línea 38:		Línea 35:

	==Procedure==		==Procedure==
			[[File:Ant Neck Cric.png\|thumb\|Anterior neck anatomy with site of initial surgical cricothyrotomy incision (red line).]]
			[[File:Larynx external Cricothyrotomy.gif\|thumb\|Landmarks for Cricothyrotomy]]
			[[File:Surgical cricothyrotomy.JPG\|thumb]]
	===Scalpel-[[Bougie]] Technique:===		===Scalpel-[[Bougie]] Technique:===
	Note that this technique is preferred as it requires no specialized equipment and can be performed quickly relative to other techniques		Note that this technique is preferred as it requires no specialized equipment and can be performed quickly relative to other techniques
Línea 51:		Línea 51:
	*Inflate balloon		*Inflate balloon
	*Secure tube and confirm placement as with other techniques		*Secure tube and confirm placement as with other techniques
	~~[[File:Surgical cricothyrotomy.JPG\|thumb]]~~

	===Standard Technique:===		===Standard Technique:===

Rossdonaldson1: /* Indications */

2024-04-17T21:30:01Z

Indications

← Revisión anterior		Revisión del 21:30 17 abr 2024
Línea 1:		Línea 1:
	==Indications==		==Indications==
			[[File:F8.png\|thumb\|External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.]]
			[[File:Cartilages and ligaments of the larynx.png\|thumb\|The cartilages and ligaments of the larynx seen posteriorly.]]
	[[File:Ant Neck Cric.png\|thumb\|Anterior neck anatomy with site of initial surgical cricothyrotomy incision (red line).]]		[[File:Ant Neck Cric.png\|thumb\|Anterior neck anatomy with site of initial surgical cricothyrotomy incision (red line).]]
	*'Can't intubate, can't ventilate'		*'Can't intubate, can't ventilate'

Jonrako: /* Procedure */

2021-07-28T19:08:08Z

Procedure

← Revisión anterior		Revisión del 19:08 28 jul 2021
Línea 49:		Línea 49:
	*Inflate balloon		*Inflate balloon
	*Secure tube and confirm placement as with other techniques		*Secure tube and confirm placement as with other techniques

	[[File:Surgical cricothyrotomy.JPG\|thumb]]		[[File:Surgical cricothyrotomy.JPG\|thumb]]

Jonrako: /* Scalpel-Bougie Technique: */

2021-07-28T19:07:16Z

Scalpel-Bougie Technique:

← Revisión anterior		Revisión del 19:07 28 jul 2021
Línea 49:		Línea 49:
	*Inflate balloon		*Inflate balloon
	*Secure tube and confirm placement as with other techniques		*Secure tube and confirm placement as with other techniques

			[[File:Surgical cricothyrotomy.JPG\|thumb]]

	===Standard Technique:===		===Standard Technique:===

Blsimpso: /* External Links */

2021-07-17T13:20:08Z

External Links

← Revisión anterior		Revisión del 13:20 17 jul 2021
Línea 97:		Línea 97:

	==External Links==		==External Links==
	*[https://~~emedicine~~.~~medscape~~.com/~~article~~/~~80241~~-~~overview~~#~~showall Medscape~~ - Surgical Airway ~~Techniques~~]		*[https://www.merckmanuals.com/professional/critical-care-medicine/respiratory-arrest/surgical-airway#v28605119 Merk Manual - Surgical Airway]
			*[http://www.emdocs.net/unlocking-common-ed-procedures-bougie-nights-the-surgical-airway-revisited/ emDocs - Bougie Nights: The Surgical Airway Revisited]

	===Videos===		===Videos===

Blsimpso: /* External Links */

2021-07-02T14:06:55Z

External Links

← Revisión anterior		Revisión del 14:06 2 jul 2021
Línea 97:		Línea 97:

	==External Links==		==External Links==
			*[https://emedicine.medscape.com/article/80241-overview#showall Medscape - Surgical Airway Techniques]

	===Videos===		===Videos===

Rossdonaldson1 at 17:38, 15 April 2021

2021-04-15T17:38:36Z

← Revisión anterior		Revisión del 17:38 15 abr 2021
Línea 1:		Línea 1:
	==Indications==		==Indications==
			[[File:Ant Neck Cric.png\|thumb\|Anterior neck anatomy with site of initial surgical cricothyrotomy incision (red line).]]
	*'Can't intubate, can't ventilate'		*'Can't intubate, can't ventilate'
	**Need to secure an airway and cannot do so by non-surgical means		**Need to secure an airway and cannot do so by non-surgical means

Rossdonaldson1: /* Videos */

2021-02-18T17:32:00Z

Videos

← Revisión anterior		Revisión del 17:32 18 feb 2021
Línea 98:		Línea 98:

	===Videos===		===Videos===
	**EMCrit (0:50) https://www.youtube.com/watch?v=Q0RVlgwC9rs&feature=emb_logo		*EMCrit (0:50) https://www.youtube.com/watch?v=Q0RVlgwC9rs&feature=emb_logo
	**EMCrit (0:58) https://www.youtube.com/watch?v=WnTBm5f_ihQ&feature=emb_logo		*EMCrit (0:58) https://www.youtube.com/watch?v=WnTBm5f_ihQ&feature=emb_logo
	**Henneman (6:59) https://www.youtube.com/watch?v=bIbl6zgWBjg&feature=emb_logo		*Henneman (6:59) https://www.youtube.com/watch?v=bIbl6zgWBjg&feature=emb_logo

	==References==		==References==