Open Cricothyrotomy Technique

1. Identify the thyroid cartilage and the cricothyroid membrane directly caudally.

2. Cleanse skin surface with appropriate antibacterial medication.

3. Anesthetize skin surface with 1% lidocaine.

4. While stabilizing the trachea with the gloved nondominant hand, make a vertical incision through the skin overlying the cricothyroid membrane.

5. Dissect the tissues over the cricothyroid membrane in a horizontal direction, until the cricothyroid membrane is exposed.

6. Incise the cricothyroid membrane horizontally and insert a tracheal hook to stabilize and control the trachea.

7. If a tracheal dilator is available, insert it into the trachea to dilate and control the trachea to facilitate tube insertion.

Insert a cuffed tracheostomy tube, or a 6.0 ID endotracheal tube.

9. Inflate cuff and initiate ventilation. Figure 22.88.

Source: Knoop KJr Stack LB. Storrow AB, Thurman RJ: The Atlas of Emergency Medicine, 3rd Edition: nttp://wivw.-accessmedicine.tcm Copyright © The ilcGranHHil! Companies, Inc. All rights Teserved,

Incision over Cricothyroid Membrane. Stabilize the proximal trachea; make a vertical incision over the cricothyroid membrane. (Photo contributor: Lawrence B. Stack, MD.)

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