Airway - Surgical Cricothyrotomy

Airway - Surgica= l Cricothyrotomy

<= span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>Clin= ical Indications:

______ 1. A surgical procedure that provides ventilation and oxygenation for patients in whom airway control

is not possible by other means.

______ 2. Patients with severe facial or nasal injuries that preclude oral or nasal intubation.

______ 3. After RSI, when all other methods of airway contr= ol are unsuccessful.

Contraindications:

______ 1. Inability to identify anatomical landmarks.<= /o:p>

______ 2. Tracheal transsection=

______ 3. Acute laryngeal disease caused by trauma or infec= tion

______ 4. Children under 8 years of age

<= span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>Proc= edure:

______ 1. Assess the need for the procedure. Receive and confirm orders f= or the procedure or perform

according to standing orders.

______ 2. If spinal trauma is indicated, maintain inline stabilization throughout the procedure.

______ 3. Prepare necessary equipment.

______ 4. Cleanse the neck with Betadi= ne and alcohol.

______ 5. Locate the anatomical landmarks of the neck and <= span class=3DSpellE>cricothyroid membrane by palpation inferior to the

thyroid cartilage and superior to the cricoid cartilage.

______ 6. Make a 2 cm horizontal incision with the scalpel = at the level of the cricothyroid membrane. (A vertical

incision may be made if necessary)

______ 7. Open the incision of the cri= cothyroid membrane by inserting the scalpel handle (or by using the Magill

forceps). = Rotate it 90 degrees to allow placement of the ET tube.

______ 8. Insert the ET tube, preferably using a smaller one (6.0 or 6.5) than normal to avoid damage to membrane.

______ 9. Once in place, the cuff should be inflated and the tube secured.

______ 10. Connect the BVM and provide ventilation with the highest oxygen concentration available.

______ 11. Auscultate for bilateral breath sounds and the absence of epigastric<= /span> sounds. This should be repeat= ed

often especially after movement of the patient.

______ 12. Con= firm the placement of the tube by using an end-tidal CO2 detector or esophageal = bulb device.

______ 13. Document the procedure, ET tube size, time, devic= es used for confirmation of the tube placement and

patient’s response in the electronic PCR.

<= span style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'>Cert= ification Requirements:

Succ= essfully complete a biannual evaluation including the indications, contraindications, technique, and possible complications of the procedure.