Clinical Tips & Tricks In Anesthesia

Emergency Ventilation via Large-Bore Needle through Cricothyroid Membrane

 

Problem:

Obstructed airway; inability to ventilate/intubate despite traditional maneuvers.

Clinical situation rapidly deteriorating.

 

Action:

1. Call for Help

2. Consider large-bore needle ventilation through cricothyroid membrane 
while help arrives

Required Equipment:

1. Large bore Intracath (#14)
2. 3cc syringe
3. Connector from 7.0 ETT

4. Breathing Circuit/Ambu Bag

Anatomy:
Technique: Locate cricothyroid membrane:

A. Palpate thyroid cartilage w/ index finger
B. Slide caudad, feel for next ridge (cricoid cartilage)
C. Staying midline, feel for small triangular soft spot above this ridge 
     (cricothyroid membrane)
D. Insert large-bore intracath through membrane, remove needle, leaving plastic cannula in place.
E. Slide ETT Connector into syringe barrel, attach to intracath.
F. Ask circulator/assistant to stabilize device.
F. Ventilate w/ 100% O2 via Breathing Circuit or Ambu Bag 
      (will need HIGH Insp. Pressure)

Assembled device:
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