Trauma: Emergency Surgical Airway

Basics

• Used as a Temporary Measure Until a Formal Tracheostomy Can Be Performed in a Controlled Setting
• Cricothyroidotomy is Too Superior in the Neck to Allow Long-Term Airway Control – Risk for Tracheal Stenosis
• Only Contraindication: Young Age (Age < 10-12 Years)
  • Membrane Too Delicate & Unable to Palpate Cricothyroid Membrane
  • Needle Cricothyroidotomy (Transtracheal Needle Jet Ventilation) if Surgical Airway Required

Standard Technique

• Incise Skin (Vertically – Limits Bleeding)
  • Use Hands to Stabilize the Trachea if Able
• Palpate & Incise the Cricothyroid Membrane (Horizontally) – Between Thyroid & Cricoid Cartilages
• Insert Trousseau Dilator or Finger into Trachea
  • Consider Placing Bougie Along the Finger into the Trachea to Guide Tube
• Insert Tracheostomy Tube or Endotracheal Tube
• *There will Be Bleeding – Secure Airway Before Managing Bleeding

Rapid Four-Step Technique (RFST)

• Palpate Cricothyroid Membrane
• Stab Incision Through Skin & Membrane
• Hook & Retract Larynx Caudally
• Insert Tracheostomy Tube

Seldinger Technique

• Uses Needle & Guidewire

Complications

• Pneumothorax
• Bleeding
• Tracheal Stenosis
• Thyroid Cartilage Fracture
  • Can Cause Vocal Cord Dysfunction/Paralysis After Decannulation