Cricothyroidotomy

life saving, emergency procedure including all types of cricothyroidotomy

1. Scenario Dr Aftab was travelling on motorway when suddenly a car ahead of him met an accident, he parked his car and rush to the scene of accident. He managed to retrieve the semi unconscious driver. On examination he was unable to breath properly. Dr Aftab cleared his mouth and lift his chin to facilitate the respiration but the situation was not improving. The breathing was becoming labored and it seem that soon the driver will be unable to breath due to obstruction. Suddenly something flashed in the mind of Dr Aftab and he rushed towards his car…….

2. Cricothyroidotomy By Col Saeed Ullah MBBS, FCPS Classified ENT, Head and Neck Surgeon

3. Definition

4. Types Needle cricothyrotomy Open surgical cricothyroidotomy Per-cutaneous cricothyroidotomy

5. Anatomy

6. Surgical anatomy

7. Needle cricothyrotomy

8. Indications Airway obstruction proximal to the sub-glottis Respiratory failure Pulmonary toilette in patients unable to clear copious secretions Bronchoscopy

9. Steps

10. Contraindications Inability to identify surface landmarks Airway obstruction distal to sub-glottis e.g. tracheal stenosis or transection Laryngeal cancer: cricothyroidotomy so as not to seed the soft tissue of the neck with cancer cells Coagulopathy (other than emergency situation

11. Complications: Early Bleeding Paratracheal false tract Posterior tracheal wall perforation into oesophagus Pneumothorax, surgical emphysema Hypercarbia and barotrauma

12. Complications: Late • Glottic or subglottic stenosis • Dysphonia • Persistent stoma • Tracheoesophageal fistula

13. Scenario Dr Aftab, an anesthetist was working in his OT, received an emergency of facial trauma. The staff immediately responded by passing the IV line and connect the patient with cardiac monitor and pulse oximeter. Dr Aftab tried to oxygenate the patient, initially it worked but the O2 saturation was not improving when he decided to intubate the patient. Due to the mandibular fracture he was unable to intubate, the clock was clicking and O2 saturation was going down, seeing the worsening situation Aftab decided to use alternative airway….

14. Open surgical cricothyroidotomy

15. Percutaneous cricothyroidotomy

16. Thank you