Emergency Cricothyroidectomy

Posted by e-Medical PPT Sunday, December 18, 2011
DEFINITION -
An emergency surgical procedure where an incision is made through the skin and cricothyroid membrane which allows for the placement of an endotracheal tube into the trachea when airway control is not possible by other methods.

INDICATIONS
Obstructed Airway - obstructions within the airway will usually prevent the passage of an endotracheal tube or prevent the establishment of a patent airway.  Therefore, a surgical airway distal to the obstruction is required.
Congenital deformities of the oropharynx or nasopharynx which inhibit or prevent nasotracheal or orotracheal intubation
Trauma to the head or neck which would preclude the use of an ambu-bag, oropharyngeal airway, nasopharyngeal airway, or endotracheal tube insertion
Cervical Spine fractures, or highly suspect fractures in a patient who requires an airway but whom nasotracheal intubation is contraindicated.  Examples include:
Nasal bone fractures
Cribiform fractures
The healthcare provider is unable to establish an airway by any other means and this is the “last resort.”

ADVANTAGES OF EMERGENCY CRICOTHYROIDOTOMY
For an emergency cricothyroidotomy the laryngeal prominence and cricoid cartilages are palpated and entry is made through the median cricothyroid ligament. This procedure is preferable to a tracheotomy as there are no large midline vessels in front of the median cricothyroid ligament whereas there are in front of the superior part of the trachea.


CONTRAINDICATIONS
Massive trauma to the larynx or cricoid cartilage:
Damage to the affected structures will make it impossible to perform the procedure properly
If another means of establishing an airway has not been performed.  Examples include:
Heimlich maneuver, nasotracheal or orotracheal intubation

COMPLICATIONS
Major bleeding is caused by the laceration of any major vessels (carotid artery or jugular vein) within the neck. 
NOTE:  Very Heavy bleeding is common and normal.
Treatment:  Same as minor bleeding.  However, if bleeding is not controlled with pressure, the vessel may need to be ligated.

Esophageal Perforation or Tracheoesophageal Fistula
Definition:  The creation of a hole between the esophagus and trachea
Causes:
Creating an incision too deep through the cricoid membrane
Forcing the endotracheal tube through the cricoid membrane and into the esophagus

Hemorrhage
Is the most common complication
Minor bleeding is caused by the laceration of superficial capillaries in the skin tissue
Note:  The Thyroid Gland may extend into the area of the cricothyroid membrane, heavy bleeding can be experienced.
Treatment:  Direct pressure to control the bleeding and then the application of a simple pressure dressing

Subcutaneous Emphysema
Definition:  The presence of free air or gas within the subcutaneous tissues
Causes:
Creating too wide of an incision will encourage air entrapment under the subcutaneous tissue
Air leaking out of the insertion site may get trapped under the subcutaneous tissues

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