Bougie Cricothyrotomy

Materials

1. Bougie
2. Scalpel/Knife
3. ET tube size 6 (or size 6 Shiley) with syringe pre-attached ready to inflate
4. Ambu-bag with EtCO2 pre-attached

Steps

• Landmark: Feel for and stabilise Cricothyroid membrane* with non-dominant hand
• 2 cm horizontal incision and bluntly dissect with finger
• Insert bougie until it stops advancing feeling for the tracheal ring thugs
• Insert the ET tube (or Shiley) and stop once the balloon is inside
• Inflate balloon, connect to ambu-bag, check EtCO2

*Cricothyroid membrane: between thyroid cartilage (Adam's apple) and cricoid cartilage (inferiorly)

- If not obviously palpable, make a vertical incision first and blunt dissections to feel for landmarks

Indications:

1. Failed Airway

2. Difficult Anatomy

3. Excessive Blood in Mouth or Nose

4. Facial trauma

5. Airway Obstruction due to angioedema, trauma, burns or foreign body obstructing the airway

Note that cricothyrotomy is still above subglottic stenosis (eg. post intubation; large goitre) and therefore this procedure won't solve it. If it is above clavicle, it is ENT, if below = thoracic surgeon.

Link video