Trauma Guideline Manual - SUNY Upstate Medical University

152____________ Trauma Guidelines ManualSUNY Upstate Trauma CenterPROCEDURE GUIDELINES: CRICOTHYROTOMYOBJECTIVES:1. To provide a guideline for the indications for the need for a surgical airway.2. To provide guidelines for the performance of a cricothyrotomy.DEFINITION:Cricothyrotomy: A surgical procedure to gain an airway in which a tube is placed through thecricothyrotomy membrane.GUIDELINES:1. Indications:a. An inability to get an emergent airway after an adequate attempt at endotrachealintubation.b. An initial approach to the airway in patients with:i. Severe facial trauma with distortion of the face and nose.ii. Upper airway obstruction.iii. Fracture of the larynx.2. Equipment:a. 6-0 tracheostomy tube (or smaller for younger patients)b. Betadine,c. Cricothyrotomy tray.d. Alternative to cricothyrotomy tray:i. #15 scalpel.ii. Hemostat.iii. Sponges.3. Procedure:a. Prep neck with betadine or Duraprep.b. Surgeon and assistant should stand on opposite sides of the patient’s head.c. Continued attempts at endotracheal intubation should continue until the surgical teamis ready to make an incision.d. Surgeon should stabilize the thyroid cartilage with his non-dominant hand.e. Make a transverse or longitudinal incision over the cricothyroid membrane.f. Incise through membrane, being careful not to disrupt the thyroid cartilage or cricoidcartilage.g. Insert hemostat with the curve of the tines up into the trachea. Or your index fingerthrough cricothyroid opening to dilate the opening to an appropriate size.h. If you are in the trachea now release your tracheal stabilization and grasp the hemostatwith your non-dominate hand. (This assures control of the trachea at all times.)i. Insert an endotracheal tube (size 6 or less) or into the cricothyroid opening.(NOTE:Although a tracheostomy tube could be used it is NOT advised since it is harder toplace accurately and may make a false passage) Make sure that the tube is notadvanced past the carina.j. Inflate cuff and ventilate patient with bag-valve-mask.k. Confirm intratracheal position with a carbon dioxide detector and CO2 manometry.l. Observe chest movement and auscultate chest to determine adequate air insufflation.