User:Mr. Ibrahem/Cricothyrotomy

Cricothyrotomy is a cut through the skin and cricothyroid membrane to establish an airway when other means of ventilating a person, such as intubation and bag valve mask fail. This may include in the setting of excessive bleeding within the mouth or facial trauma.

While the procedure can be done in a number of ways, a common technique is the "scalpel-finger-bougie". The first step is locating the cricothyroid membrane (CTM) between the thyroid and cricoid cartilage. A 4 cm vertical cut is made through the skin. A horizontal cut is made through the CTM. A finger and then a bougie is placed in the hole. A 6.0 ET tube is then placed over the bougie until the cuff just disappears at which point it is inflated. In children a 4.0 ET tube may be used.

Signs of success include end-tidal CO2 and chest rise on both sides. The ET tube is than secured in place. In those at high risk, set up for a cricothyrotomy may be done before starting intubation. The procedure is not recommended in those under the age of 5 to 12 years, though jet ventilation may be done in younger people. Cricothyrotomy is easier to perform than a tracheotomy, though this procedure may be performed at a later date.

Use has become less common due to other improvements in airway management. In the emergency room, they are carried out in less than 3 in 1,000 intubations, with most being done due to trauma. The procedure was first formally carried out in 1909, though did not come into common use until the 1970s. The average time to perform the procedure is just over a minute.