Emergency airway puncture - series

Normal anatomy

The larynx is a tubular structure in the neck, through which air passes to the lungs. The thryoid and cricoid cartilage form the narrowest section of this airway.

Normal anatomy

Indications

The area of the larynx bounded by the thyroid and cricoid cartilage is a frequent site for obstruction, either by swallowed foreign bodies or abnormal tissue growths. A cricothyrotomy is an emergency procedure that relieves an airway obstruction until formal surgical placement of a breathing tube (tracheostomy) is performed.

Indications

Incision

If the situation is acute, a hollow needle is inserted into the throat, just below the Adam's apple (thyroid cartilage). This is called a needle cricothyrotomy. More frequently, a small incision is made in the skin over the cricothyroid membrane, and another incision is made through the membrane between the cricoid and thyroid cartilage.

Incision

Procedure

A tube that enables breathing is inserted through the incision.

Procedure

Aftercare

Cricothyrotomy is generally followed by a surgical tracheosotomy, if there is need for a prolonged use of a breathing tube. Removal of breathing tubes from both a cricothyrotomy and tracheostomy is usually followed by prompt healing of the incision site.

Aftercare

Revision

Last reviewed 7/16/2011 by Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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