• Patients who cannot be adequately oxygenated
or ventilated using bag-mask ventilation.
• Patients in whom it is impossible to establish an airway via
oral or nasal endotracheal intubation due to any of the following:
• Bleeding from upper airway structures.
• Massive emesis.
• Masseter spasm.
• Spasm of the larynx or pharynx.
• Laryngeal stenosis.
• Structural deformities of the upper airway.
• To avoid delay in airway control in patients with upper airway
obstruction, thus preventing or shortening periods of anoxia.
• Patients with maxillofacial trauma, laryngeal trauma (except
for tracheal transection), and unstable cervical spine fractures
to minimize movement of the neck.
• An elective situation when a patient is undergoing surgery of
the head, face, or neck.
• Cricothyrotomy should not be performed in any
patient who can quickly and easily be intubated using nonsurgical
• Patients with a fractured or significantly damaged larynx.
• Patients with tracheal transection.
• The cervical fascia may be tenuously holding the airway together.
• The incision required to perform a cricothyrotomy may transect
the fascia causing the distal airway to retract into the mediastinum.
• In such cases, tracheostomy is the preferred method for controlling
• Preexisting infection.
• Significant neck distortion.
• Massive neck edema.
• In children younger than 5 years, needle cricothyrotomy with
transtracheal jet ventilation is recommended due to the difficulty
of performing a surgical cricothyrotomy. (Some clinicians recommend
transtracheal jet ventilation for children younger than 12 years.)
• Establishing an airway should supersede any relative contraindication
in a patient in extremis.
• Tracheal dilator (Trousseau dilator) or spreader or hemostat.
• Appropriate size tracheostomy or endotracheal tube.
• 25-gauge needle and syringe with 1% lidocaine (for local anesthesia).
• Preparation solution (either 2% chlorhexidine-based
preparation in patients older than 2 months of age or 10% povidone-iodine).
• Sterile gauze pads.
• Ties for tracheostomy tube.
• Oxygen source and suction.
• Bag-valve device.
• Remember, the thyroid gland lies inferior to
the larynx. Therefore, if the thyroid gland is visualized, the incision should
be extended cranially, toward the larynx.
• After making an incision through the cricoid membrane, it may
be necessary to lift and hold the larynx anteriorly with a tracheal
hook in order to avoid posterior displacement of the larynx.
• If needle cricothyrotomy is performed and there is no pressurized
oxygen source available, the patient can be ventilated using ...
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