Page 43 - PJ MED OPS Handbook 8th Ed

5. Umbilical tape or other means of securing tracheostomy or ETT
6. 4 × 4 gauze to control bleeding
7. 1–2% lidocaine, syringe and needle for local anesthesia, if patient
is awake. Also can use 100mg ketamine (1mg/kg) IV to achieve
dissociation Thyroid
8. 8 inch piece of elastic gum bougie cartilage
Cricothyroid
Membrane
Cricoid
cartilage
Thyroid cartilage
Incision

Cricoid cartilage

Procedure:
1. Expose anterior neck and prepare equipment.
2. Identify cricothyroid membrane, swab with
beta dine or alcohol if time permits.
3. If patient is conscious, infiltrate area with lido-
caine after performing procedural sedation.
4. Make 1-inch vertical incision in the skin overly-
ing the cricothyroid membrane.
5. Holding the larynx between the thumb and mid-
dle finger with the index finger in the incision
over the cricothyroid membrane, push scissors/
blade over index finger into membrane.
6. After entering trachea, spread opening. Thyroid cartilage
Cricothyroid
7. Insert bougie through the incision into trachea, Start incision Membrane
here
directing it caudally (towards the lungs) to con- Cricoid cartilage
firm placement and maintain patency of the in-
cision. Bougie should advance freely in trachea,
any resistance could indicate improper place-
ment within the subcutaneous tissue.
8. Place tube over bougie and insert into trachea.
9. Inflate the balloon, remove bougie, check breath sounds, EtCO2, secure tube and dress incision
site.

PJ PEARLS:
• Use non-dominant hand to stabilize trachea between thumb and last 3 fingers and your
index finger to locate/track the cricoid cartilage prior to making the incision.
• If the patient has a large neck use a syringe and needle to aspirate air and confirm place-
ment within the airway. Leave the needle in place as a marker to make your incision and
then stab into the airway.

Chapter 6. Surgical and Medical Procedures n 41