View source for Needle cricothyrotomy

==Indications==
[[File:F8.png|thumb|External views of the larynx: (a) anterior aspect; (b) anterolateral aspect with the thyroid gland and cricothyroid ligament removed.]]
[[File:Cartilages and ligaments of the larynx.png|thumb|The cartilages and ligaments of the larynx seen posteriorly.]]
*Failed airway in adults or children
**Preferred method of rescue airway in infants and children (cutoff 5-12 years of age, depending on source<ref>Roberts, et al.(2014). Roberts and Hedges' clinical procedures in emergency medicine.</ref>)
*Temporizing measure until definitive airway management
**Will provide adequate oxygenation, but will NOT provide adequate ventilation
*Obstruction above the level of the cricothryoid membrane

==Contraindications==
When used as a rescue airway, no absolute contraindications.

*Relative Contraindications
**Inability to identify landmarks
**Tracheal transection or severe trauma
**Underlying tumor, abscess/infection, or other known abnormality

==Equipment==
*Povidone iodine
*Sterile drapes, gloves, gown, gauze
*12-14 G angiocath
*3mL syringe x 2
*Adapter to 7-0 ETT or adapter to 3-0 ETT
*BVM appropriate for size of patient
**Can also use jet vet ventilation setup in adults
***High flow O2 source, 50 PSI
***O2 tubing
***Valve-3 way stop cock or cut holes in O2 tubing
***Depending on O2 source, calculate time valve must be open for tidal volume
***BVM setup does not allow adequate exhalation in adults

==Procedure==
[[File:Cricothyrotomy.png|thumb|(1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea '''(A) Cricothyrotomy site''' (B) Tracheotomy site]]
#Prep and drape
#Locate cricothyroid membrane
#Pierce membrane with angiocath directed 30-45 deg caudal
#*Attach 3mL syringe with saline, aspirate as you enter
#*Advance until air is aspirated in syringe
#Advance catheter over needle, hub to skin
#*Remove needle
#Attach 3-0 ETT adapter directly to angiocath (best option)
#*OR attach 3 mL syringe to catheter, then attach 7-0 ETT adapter to syringe
#*OR attach 10 mL syringe to catheter, then insert actual 7-0 ETT (works best with cut down ETT) into syringe and blow up balloon so that ETT does not move
#Attach BVM to ETT adapter
#Secure system
#Ventilate with BVM or high flow O2 setup
#OBTAIN DEFINITIVE AIRWAY
#*Should be used for < 45 minutes

==Complications==
*Hemorrhage
*Infection
*Tracheal stenosis
*Subcutaneous emphysema
*Posterior tracheal perforation

==See Also==
*[[Intubation]]
*[[Surgical airways]]

==External Links==
*[https://emcrit.org/emcrit/cricothyrotomy-needle-or-knife/ EMCrit: Needle vs Knife: Part I]

===Videos===
*EMCrit (0:50) https://www.youtube.com/watch?v=Q0RVlgwC9rs&feature=emb_logo 
*EMCrit (0:58) https://www.youtube.com/watch?v=WnTBm5f_ihQ&feature=emb_logo
*Henneman (6:59) https://www.youtube.com/watch?v=bIbl6zgWBjg&feature=emb_logo

{{#widget:YouTube|id=a4I0MEwtXFY}}

==References==
<references/>

[[Category:Critical Care]]
[[Category:ENT]]
[[Category:Procedures]]