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1. Cricothyroidotomy Moderated by – Dr.S.D.Mandolkar sir

2. Definition - Cricothyroidotomy is an emergency procedure involving incising or puncturing the cricothyroid membrane to access the trachea for ventilation purpose.

3. Indication- Inability to intubate. Inability to ventilate. Severe facial or nasal Injuries. Massive mid facial trauma.

4. Procedure Using a scalpel. - Patients neck is extended and the area between the prominence of the thyroid cartilage and the cricoid cartilage below is palpated with the index finger of the freehand and if necessary the laryngeal handshake technique can be used to define the membrane.

5. Laryngeal handshake technique A) the index finger and thumb grasp to the top of the larynx and roll it from side to side. The bony and the cartilagenous cage of the larynx is a cone which connects to the trachea. B) The fingers and the thumb slide down over the thyroid lamina C) The middle finger and the thumb rest on the cricoid cartilage with the index finger palpating the cricothyroid membrane.

6. Scalpel bougie tube technique It is the fastest and most reliable method of securing the airway.

7. Required instruments A number 10 blade A bougie A 6 mm cuffed endotracheal tube And the patient should be receiving 100% Oxygen and full neuromuscular blockade.

8. Procedure A vertical skin incision is recommended with dissection rapidly carried down to the crico thyroid membrane. A one centimetre transverse incision is made through the membrane immediately above the cricoid cartilage and the scalpel twisted through a right angle to gain access to the airway .

9. If available an artery forceps bougie , dilator or tracheal hook will improve the aperture and insertion of an available tube.

10. Cannula cricothyroidotomy Cannula cricothyroidotomy can be performed with a narrow bore ( internal diameter less than or equal to 2 mm) or wide bore (internal diameter is greater than or equal to 4 mm) cannula to facilitate oxygenation.

11. Contraindication Inability to identify landmarks Underlying anatomical abnormalities Small children under 10 years age Acute laryngeal disease due to infection or trauma

12. Complications Esophageal perforation may occur when the blade penetrates to deeply Hemorrhage may occur if a vessel is ruptured.