Surgical and Nonsurgical Cricothyrotomy - ppt download

By A Mystery Man Writer

Surgical and Nonsurgical Cricothyrotomy Used when conventional techniques fail Be familiar with: Anatomy of the anterior aspect of the neck Important blood vessels in area
Used when conventional techniques fail. Be familiar with: Anatomy of the anterior aspect of the neck. Important blood vessels in area.
Incising the cricothyroid membrane. Inserting an ET or tracheostomy tube directly into the subglottic area of the trachea. Cricothyroid membrane is ideal for surgical opening into the trachea.
Modified cricothyrotomy (Seldinger technique) Device that functions as an introducer and an airway. Courtesy of Cook Medical.
Patent airway cannot be secured with conventional means. Severe foreign body obstructions. Swelling of airway. Maxillofacial trauma. Inability to open mouth.
Ability to secure a patent airway. Inability to identify anatomic landmarks. Crushing injuries to the larynx and tracheal transection. Underlying anatomic abnormalities. Age younger than 8 years.
Do not need to manipulate cervical spine. Disadvantages. Difficult to perform in children and patients with short, muscular, or fat necks. More difficult than needle cricothyrotomy.
Severe bleeding from laceration of the external jugular vein. Risks of perforating the esophagus and damaging the laryngeal nerves. Taking too long will result in hypoxia. Subcutaneous emphysema from tube misplacement.
If a commercial kit is not available, prepare: Scalpel. ET or tracheostomy tube. Commercial device (or tape) to secure tube. Curved hemostats. Suction apparatus. Sterile gauze pads. Bag-mask device attached to 100% oxygen.
Proceed rapidly yet cautiously. Palpate for V notch of thyroid cartilage. Slide index finger into depression between thyroid and cricoid cartilage. That is the cricothyroid membrane.
Partner prepares equipment. Maintain aseptic technique. Stabilize larynx; make a 1- to 2-cm vertical incision over the cricothyroid membrane.
Insert a 6.0-mm cuffed ET tube or a 6.0 tracheostomy tube into trachea. Inflate the distal cuff. Attach the bag-mask device, and ventilate while your partner auscultates.
Confirm proper tube placement. Ensure bleeding has been controlled. Secure tube and continue to ventilate.
14- to 16-gauge over-the-needle IV catheter inserted into the trachea. High-pressure jet ventilator attached to catheter hub. Translaryngeal catheter ventilation.
Indications. Inability to ventilate by less invasive means. Maxillofacial trauma. Inability to open mouth. Uncontrolled oropharyngeal bleeding. Contraindications. Severe airway obstruction above catheter insertion. High-pressure ventilator leads to barotrauma and pneumothorax. If equipment is not immediately available.
Advantages. Easier than open cricothyrotomy. Lower risk of damaging structures. Allows for intubation. No manipulation of cervical spine. Disadvantages. Does not provide protection from aspiration. Technique requires a specialized, high-pressure jet ventilator.
Complications. Improper placement can cause severe bleeding. Excessive air leakage can cause subcutaneous emphysema and compression of the trachea. Overinflation of lungs: barotrauma. Underinflation of lungs: hypoventilation.
Large-bore IV catheter (14–16 gauge) 10-mL syringe. 3 mL of sterile water or saline. Oxygen source (50 psi) High-pressure jet ventilator device and oxygen tubing.
Draw up approximately 3 mL of sterile water or saline into a 10-mL syringe. Attach to IV catheter. Place head in neutral position. Locate the cricothyroid membrane. Cleanse area if time permits.
Stabilize the larynx; insert the needle at a 45° angle toward the feet. You should feel a pop as the needle penetrates the membrane. After a pop is felt, insert needle 1 cm farther; aspirate with the syringe.
Advance catheter over needle until catheter hub is flush with skin. Withdraw the needle; dispose of properly. Attach one end of the oxygen tubing to the catheter; other end to the jet ventilator.
Begin ventilations by opening the release valve on the jet ventilator. Turn release valve off with chest rise. Secure catheter and continue ventilations.