(6) Dilate the opening by inserting the blunt end of the scalpel handle into
the incision and rotate it 90 degrees to open the airway. Alternately, a hemostat may be
used in place of the scalpel handle. You can also use a manufactured or improvised
hook device to hold the membrane open as you prepare for the next step in the
(7) Insert the cuffed endotracheal tube cut down to just above the pilot
balloon into the cricothyroid membrane incision, directing the tube down the trachea
approximately 4.5 mm in a caudal direction. Inflate the cuff with approximately 6 to 10
ml of air).
(8) Immediately ventilate the patient and auscultate all lung fields and over
the epigastrum. Confirm (symmetrical) rise and fall of the chest. It should be noted that
manually-triggered flow-restricted, oxygen-powered ventilation devices (FROPVD)
should not be used in conjunction with any of these devices.
Secure the tube with tracheal ties passed around the neck or with tape.
a. The primary function of the bag-valve-mask (BVM) system is to deliver a high
concentration of supplemental oxygen (above 55 percent) and simultaneously ventilate
the patient. When using the BVM system with an unconscious patient, the use of an
oropharyngeal airway is desirable in order to maintain the patient's airway.
b. The primary advantages of the BVM system over the mouth-to-mouth and
mouth-to-nose methods are user convenience and the ability to deliver enriched oxygen
mixtures. However, the mouth-to- mouth and mouth-to-nose methods can deliver a
greater volume of air (up to four liters at a time) than the BVM system (usually one liter).
The BVM system may also be used with or without supplemental oxygen to assist the
efforts of a spontaneously breathing patient who is having difficult respirations.
c. There are many different BVM systems in use. Most of them use these
A self-inflating bag.
A non-return valve to prevent rebreathing exhaled air.
(3) A face mask, usually made of clear plastic so that vomitus or secretions
around the patient's mouth can be seen.