Cricothyroidotomy
What the Examiner Expects
Emergency surgical airway created by incising the cricothyroid membrane, performed when endotracheal intubation fails and the patient cannot be oxygenated. The examiner expects you to know this is the definitive surgical rescue airway in a 'can't intubate, can't oxygenate' scenario. The technique involves palpating the cricothyroid membrane between the thyroid and cricoid cartilages, making a vertical skin incision followed by a horizontal stab through the membrane, dilating the opening, and inserting a small (6.0) cuffed tube. It should be converted to a formal tracheostomy within 24–72 hours to prevent subglottic stenosis.
Key Examiner Focus Points
- Emergency surgical airway when intubation fails (can't intubate, can't oxygenate)
- Incise through the cricothyroid membrane between thyroid and cricoid cartilage
- Vertical skin incision (or horizontal) → horizontal stab through cricothyroid membrane
- Use a 6.0 cuffed tracheostomy tube or endotracheal tube
- Convert to formal tracheostomy within 24–72 hours to avoid subglottic stenosis
Common Curveballs
The patient is a 10-year-old child — can you perform a cricothyroidotomy?
Surgical cricothyroidotomy is contraindicated in children < 12 years old. The cricothyroid membrane is too small and the cricoid ring is the narrowest part of the pediatric airway — injury causes subglottic stenosis. Use needle cricothyroidotomy with jet insufflation as a temporizing measure, or proceed directly to emergent tracheostomy.
After cricothyroidotomy, there is subcutaneous emphysema in the neck
This suggests a false passage or air tracking from the incision site. Confirm tube placement with end-tidal CO2 and chest X-ray. If the tube is in the correct position, the emphysema is often self-limited. If ventilation is inadequate, the tube may be in the pretracheal space — reposition under direct visualization.
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