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Procedural Skills (SLO6)
Question 23 of 127
You have been asked to teach a group of medical students about airway rescue manoeuvres. You are currently discussing cricothyroidotomy. Which of the following is an advantage of surgical cricothyroidotomy compared to needle cricothyroidotomy?
Answer:
- Advantages
- Definitive airway
- Enables ventilation and oxygenation until semi-elective intubation or tracheostomy
- Enables suctioning of trachea
- Disadvantages
- Trauma to surrounding structures
- Risk of creating false passage in soft tissues or oesophagus
- Technically more difficult than needle cricothyroidotomy
Surgical Cricothyroidotomy
Procedural Skills (SLO6)
Last Updated: 14th December 2023
Surgical cricothyroidotomy is performed by making a skin incision that extends through the cricothyroid membrane. Surgical cricothyroidotomy provides a definitive airway that can be used to ventilate the lungs until semi-elective intubation or tracheostomy is performed.
Indications
- Can't intubate, can't oxygenate scenario
Advantages vs disadvantages
- Advantages
- Definitive airway
- Enables ventilation and oxygenation until semi-elective intubation or tracheostomy
- Enables suctioning of trachea
- Disadvantages
- Trauma to surrounding structures
- Risk of creating false passage in soft tissues or oesophagus
- Technically more difficult than needle cricothyroidotomy
Procedure
- Extension of the neck will improve surgical access and exposure
- Palpate the thyroid notch, cricothyroid interval, and sternal notch for orientation
- Make a horizontal stab incision through the cricothyroid membrane into the trachea with the scalpel (preferably 20 blade: rounded rather than pointed)
- Open the incision with tracheal dilators or clip (with the scalpel blade still in situ)
- Remove the scalpel blade and insert the intubating bougie into the trachea
- Railroad the tracheal tube (6 or 7 mm cuffed) over the intubating bougie to place it in the trachea
- Inflate the cuff and confirm the tube position
- Secure the tube to the patient to prevent dislodging
Complications
- Aspiration of blood
- Creation of false passage into the tissues
- Subglottic stenosis/oedema
- Laryngeal stenosis
- Oesophageal laceration
- Thyroid laceration
- Haemorrhage or haematoma formation
- Perforation of posterior tracheal wall
- Subcutaneous and/or mediastinal emphysema
- Vocal cord paralysis, hoarseness
Clinical anatomy
Site of Airway Procedures. (Image by By PhilippN [CC-BY-SA-3.0 , via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
