As ED physicians, we fear the patient we can’t intubate, can’t ventilate. We’ve had a rash of emergency cricothyrotomies in our ED recently. Though rare, you never know when you might need to perform this life saving procedure. Review the brief overview of the steps of the procedure below so you’ll be ready to step up to the plate:
There 3 methods for the procedure, the most common is the knife – finger – bougie approach (described below)
Equipment:
- Scalpel 10 blade ideal
- Bougie
- Size 6-0 ETT or tracheostomy tube (shiley at Sinai, Portex at EHC)
- PPE especially eye protection!
The Procedure:
- Identify your anatomy – cricothyroid membrane is between the thyroid (superior) and cricoid (inferior) cartilages
- Use non dominant hand to stabilize thyroid cartilage. If time, betadine/chloroprep site
- Make vertical midline incision, 3-5 cm with low threshold to extend incision
- Palpate cricothyroid membrane
- Make horizontal incision in cricothyroid membrane
- Insert finger, then pass bougie
- Place ET tube or tracheostomy tube over bougie
Watch this incredible video of an actual cricothyrotomy performed by our very own Ram Parekh and Reuben Strayer, published on EmCrit:
To learn more, check out theses resources:
- Chapter 10 of Tintinalli, great Surgical Airway Section
- UpToDate Section on Cricothyrotomy
- Surgical Cricothyroidotomy – Life in the Fast Lane
