Page 209 - 2026 SMOG

PERFORM CRICOTHYROIDOTOMY
Body Isolation Precautions, if the situation permits
1. Gather, assemble, and test all necessary equipment
2. Consider sedation if the patient is conscious
3. Identify the cricothyroid membrane between the cricoid and thyroid cartilage.
4. Clean the site with antiseptic
5. Stabilize the larynx with the non-dominant hand
6. Make a 1½ inch vertical incision through the skin over the cricothyroid membrane.
7. Maintain the opening of the skin incision by pulling the skin taut with the fingers of the
nondominant hand.
8. Stabilize the larynx with one hand while cutting horizontally through the cricothyroid
membrane.
9. Insert a commercially designed cricothyrotomy hook or bougie to stabilize the opening.
10. Insert the end of the endotracheal tube into the trachea and direct it towards the lungs.
Carefully remove the hook after inserting the tube (maintain positive control of the tube until
secure)
11. Inflate the cuff with 10mL of air
12. Assess the patient for spontaneous respirations
13. Confirm placement with chest rise and fall, and placement of EtCO 2
14. Attach a pulse oximeter to the patient, if available
15. Assist with ventilations when respirations are <8 or >30 or a pulse oximeter reading in <90%
16. Secure the tube, using tape, cloth ties, or other measures, while applying a dressing to protect
the tube and incision further
**Document procedure, results, and vital signs**

2026 Standard Medical Operating Guidelines (SMOG) • 201