3-2.
CONDITIONS REQUIRING CRICOTHYROIDOTOMY
a. Trauma to the Larynx. A blow to the larynx with a blunt instrument can
cause destruction of the structure that supports the larynx. This allows the airway to
collapse during inspiration (breathing in) and to close. A blow to the larynx with a blunt
object may cause severe swelling (edema). This swelling may not occur for up to 48
hours following the injury, and the swelling may result in the airway being closed.
Monitor a casualty with possible or suspected injury to the larynx constantly during the
period immediately following such an injury.
b. Foreign Bodies/Objects. Foreign bodies such as dislocated teeth or
dentures or accumulations of blood, mucus, or vomitus. Foreign objects, accidentally
ingested and obstructing the airway, may be the greatest cause of upper airway
obstruction. In very young children, foreign objects in the airway may be the result of
not knowing how to chew and swallow properly or an underdeveloped epiglottal reflex.
In adults airway obstruction is frequently associated with eating coarse meats and
vegetables. Airway obstruction in adults is often misdiagnosed as a heart attack (cafe
coronary), but the person is really suffering from something obstructing the airway.
c. Soft Tissue Involvement. Soft tissue involvement may cause swelling which
results in the airway being obstructed. Possible reasons for the swelling include an
anaphylactic reaction or flash burns involving trauma to the larynx.
3-3.
TYPES/COMPLICATIONS
a. Types. There are two types of cricothyroidotomy: needle cricothyroidotomy
(also called percutaneous transtracheal ventilation) and surgical cricothyroidotomy.
b. Complications. Although a cricothyroidotomy is a relatively safe procedure,
complications can occur. Bleeding is the most common complication, but it is usually
minor and controllable. False passage is another complication: that is, accidentally
entering a passage other than the airway. Complications also include damage to the
vocal cords and larynx (if the incision is made incorrectly), mediastinal emphysema,
subcutaneous emphysems, and infection.
CAUTION:
Resuscitation techniques may be necessary. In such a case, use a bag-
valve--mask, demand valve resuscitator, and suction device.
3-4.
SIGNS/SYMPTOMS OF AN OBSTRUCTED AIRWAY
The absence of respiration, universal choking sign, and inability to speak are all
signs/symptoms of an obstructed airway. On looking at the casualty, you may see that
his chest is fully expanded with the rib margins being prominent while the intercostal
spaces are depressed. Another sign is slightly bluish discoloration of the skin and
mucous membrane because of oxygen deficiency (cyanosis).
MD0569
3-3
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