# Surgical Cricothyroidotomy

## Overview

This module describes how to perform surgical cricothyrotomy, a rescue airway preferred over needle cricothyrotomy in adults as it allows for more effective ventilation.

## Indications

## Contraindications

## Patient information and consent

This procedure is usually done as an emergency measure with an unconscious patient. However, it may be explained to family members afterwards.

### How do I explain this procedure?

“The patient was unable to breathe because their airway was blocked and air was not getting into their lungs. I had to make a cut in their neck and put a thin tube into their windpipe so that I could help them breathe. This is a temporary emergency measure.”

## Preparation

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### Documentation

### Equipment

## Site & Positioning

Position the patient supine. If you suspect a cervical spine injury, do not flex the neck. If the cervical spine has been cleared, a 1L bag of intravenous fluid placed behind their shoulders, so that their neck is hyperextended will assist in location of the cricothyroid membrane.

Identify the landmarks of the cricothyroid membrane. The Adam's apple is the thyroid prominence formed by the thyroid notch. Moving inferiorly, the next solid prominence is the cricoid cartilage. Immediately above the cricoid cartilage the finger slips into the depression of the cricothyroid membrane.

## Procedure

Follow medical asepsis with sterile gloves or non-sterile gloves depending on urgency and what is readily available. Since this is often an emergency procedure, non-sterile gloves and an alcohol swab may be the only aseptic preparations available.

## Troubleshooting

I don’t have a tracheotomy tube.

Use a size 5-6 endotracheal tube.

I have created a false passage.

This is extremely unlikely if you have performed a surgical cricothyroidotomy because there is minimal soft tissue overlying it. If you feel that you may have created a false tract, review your anatomy: you may be too high, too low or lateral to the cricothyroid membrane.

The neck tissue is very swollen prior to the procedure and I am struggling to locate landmarks.

While the thyroid cartilage is most visible, the cricoid cartilage is the most palpable landmark in the neck. Palpate for the cricoid cartilage and feel for the depression immediately above it. This is the cricothyroid membrane.

The neck tissue is very swollen after the procedure.

Palpate the neck. Air will present as surgical crepitus. Confirm placement of the tube and that the cuff is inflated, as it may have become dislodged and air may be tracking into the soft tissues. The patient may have developed a pneumothorax. Listen for chest sounds.

## Risks

## References