Needle Cricothyrotomy: Emergency Technique for Securing the Airway

Needle Cricothyrotomy: Emergency Technique for Securing the Airway

The provided medical document describes the technique of a needle cricothyrotomy, an emergency airway procedure. It enables oxygenation but does not provide effective ventilation of the lungs. This method is the emergency procedure of choice in children under 12 years of age and can also be applied in cases of severe facial or jaw trauma or other causes of upper airway obstruction.

Technique

• Preparation: Inform the patient or parents if possible.
• Anesthesia: Local anesthesia with 1% lidocaine and epinephrine is injected into the skin over the cricothyroid membrane and directly into the membrane itself. Aspiration of air confirms correct placement into the trachea.
• Cannula Insertion: Using a 5 ml syringe attached to the cannula, insert the tip through the lower part of the cricothyroid membrane, directing caudally (downward), while aspirating.
• Confirmation and Removal: Once free air is aspirated, advance the cannula 1–2 mm further, stop, and withdraw the needle while leaving the cannula sheath in place.
• Connection: Attach a 3-way stopcock to the cannula, then connect the oxygen tubing to the stopcock.
• Oxygen Delivery: Start oxygen flow at 15 L/min. Use the stopcock to control airflow: toward the patient for inspiration, away for expiration.
  • Inspiration phase: ~2 seconds or until chest rises.
  • Expiration phase: ~4 seconds.
• Incomplete Exhalation: If exhalation is incomplete, insert a second cannula alongside the first for venting.
• Duration: Provides sufficient oxygenation for 45–60 minutes.

Alternative Method

A 2 ml syringe may be connected to the cannula after insertion. Remove the plunger and insert the connector from a size 7 endotracheal tube into the syringe. A bag-valve mask attached to oxygen can then be connected to oxygenate the patient.

Complications

• Misplacement: Subcutaneous emphysema, hemorrhage.
• Injury to nearby structures: Vocal cords, cricoid cartilage, trachea, carotid arteries, vagus/ laryngeal nerves, jugular veins, esophagus.
• Barotrauma: Especially in infants or complete upper airway obstruction.
• Infection.

Advantages

• Lower complication rate compared to surgical airway techniques.
• Easier to perform than surgical tracheostomy.
• Requires minimal surgical skills.
• Suitable for use in small children.

Hazards / Limitations

• Does not provide a definitive airway.
• Insufficient for full ventilation.
• May expose the lungs to high pressure.
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Emergency Medicine, Cricothyrotomy, Airway Management, Medical Technique, Pediatric Emergencies

needle cricothyrotomy, emergency airway procedure, pediatric airway obstruction, cricothyrotomy technique, emergency surgery, airway management

#EmergencyMedicine #Cricothyrotomy #Airway #Medical #FirstAid #Surgery #Pediatrics