A 24-year-old man has been involved in a road traffic accident and suffered facial and thoracic injuries. The anaesthetist has been unable to intubate the patient and is going to attempt a needle cricothyroidotomy.
1. What are the anatomical landmarks for this procedure?
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Cricothyroidotomy is an important emergency procedure that can be used to obtain an airway when other, more routine methods have failed.
Needle cricothyroidotomy occurs at the cricothyroid membrane. This can be palpated anteriorly between the thyroid cartilage and cricoid cartilage.
2. Briefly outline how the procedure is carried out.
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The procedure is carried out as follows:
- Assemble and prepare oxygen tubing by cutting a hole towards one end of the tubing
- Connect tubing to an oxygen source capable of delivering > 50 psi
- Surgically prepare the neck using antiseptic swabs
- Palpate the cricothyroid membrane anteriorly between the thyroid cartilage and cricoid cartilage
- Puncture the skin in the midline and insert a 12G or 14G cannula through the cricothyroid membrane at a 45-degree angle caudally
- Confirm tracheal position by air aspiration (20ml syringe)
- Attach ventilation system to the cannula
- Commence cautious ventilation (1 second on and 4 seconds off)
- Confirm ventilation of lungs, and exhalation through the upper airway
- Ventilation can now be maintained for 30 – 45 minutes
3. Give two potential complications of needle cricothyroidotomy.
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Potential complications of needle cricothyroidotomy include:
- Inadequate ventilation, hypoxia and death
- Aspiration (blood)
- Oesophageal laceration
- Haematoma
- Perforation of the posterior tracheal wall
- Subcutaneous or mediastinal emphysema
- Thyroid perforation
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