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Surgical airway

SURGICAL AIRWAYS
Cricothyrotomy
Indications (Identified need for intubation)
Maxillofacial trauma Oropharyngeal obstruction
Edema FBAO Mass Lesion Cancer

Unsuccessful oral/nasal tracheal Difficult anatomy Massive hemorrhage/regurgitation

SURGICAL AIRWAYS
Cricothyrotomy (cont..)
Contraindications:
Age <10-12 Laryngeal crush injury Laryngeal tumor/stricture Tracheal transsection subglottic stenosis Expanding hematoma Coagulopathy Unfamiliar w/ procedure

SURGICAL AIRWAYS
Anatomy:
Thyroid cartilage Cricoid ring Cricoid cartilage Thyroid gland Trachea Major vessels

SURGICAL AIRWAYS

Netter; Atlas of Human Anatomy

SURGICAL AIRWAYS
Procedure:
Identify thyroid cartilage
Cricothyroid membrane

Vertical incision through skin


Prep prior Incise membrane

Open incision
Dilator/tracheal hook

Insert ETT/Trach tube


Ventilate patient

SURGICAL AIRWAYS
Complications:
Incorrect placement Long execution time Hemorrhage Passage sub Q Plugging Pneumomediastinum Aspiration etc.

Anderson; Grants Atlas of Anatomy

SURGICAL AIRWAYS

SURGICAL AIRWAYS
Retrograde Tracheal Intubation (RTI):
Indications
Abnormal anatomy
Pt. W/ epiglottitis Severe kyphosis Cervical spondylosis

Trauma Reasonable alternative to Surg and Needle Crike

SURGICAL AIRWAYS
RTI (cont...):
Contraindications
Trismus (w/o paralytic) Coagulopathy Enlarged thyroid

Procedure:
Supplemental O2 Catheter over needle into CTM Insert guidewire through catheter Visualize guidewire and pass tube

Dailey; The airway: emergency management

SURGICAL AIRWAYS
Needle Cricothyrotomy
Indications
Same as for any surgical airway Considered safer and quicker than surgical crike Will not compromise c-spine in trauma pt.

Contraindications
Total obstruction at or near the cords

Complications
Misdirection Puncture tracheal wall Local cord damage Does not prevent aspiration!

SURGICAL AIRWAYS
Needle Cricothyrotomy
Procedure
Supplemental O2 Catheter over needle into CTM (at least 14 ga) Attach to high pressure O2 source (50psi) Ventilate using valve or interrupter type device

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