CRICOTHYROIDOTOMY-AN EMERGENCY AIRWAY MANAGEMENT PROCEDURE

Edited by, JASPER VICTORIA

Cricothyroidotomy is an emergency airway management procedure which should be used only when there is no options for intubation or ventilation and is very essential for survival. It is done in order to overcome the obstruction of airway above the larynx.

It can be done in infection of the epiglottis, facial oedema due to angioedema or burns, maxillofacial trauma, or upper airway obstruction when an endotracheal intubation is impossible.

It is made sure that the patient doesn't have cervical-spine instability.  The patient is made to lie in a supine position with the neck extended. The notch present in the upper border of the thyroid cartilage is found by running the index finger anteriorly down the neck. The cricothyroid membrane is present as a depression between the cricoid and the thyroid cartilages below the notch. It is considered an emergency if the depression is not found and therefore the trachea is directly reached between the cricoid cartilage and the suprasternal notch. 

It may be done using a cannula and Y-connector as in needle cricothyroidotomy, or with a blade, cannula, introducer, connector and binding tape as in cricothyroidotomy kit, or with a tracheostomy tube as in surgical cricothyroidotomy.

The complications include local haemorrhage, perforation of trachea, aspiration, laryngeal or subglottic stenosis, paralysis of the vocal cord, tube blockade or hoarseness in the vocal cord.