Figure 3-3. Inserting the needle.
f. As the larynx is entered, air will pass back and forth through the needle with
the patient's respiratory activity.
g. When the needle is inside the larynx, direct it downward and toward the back
(posteriorly) to avoid penetrating the esophagus. Insert an additional needle if the
airway you have formed is not sufficient.
This procedure is more risky on a casualty with a tendency to bleed
readily or with a large, thick neck. It may be difficult to locate the
cricothyroid membrane on a person with a thick neck. If you feel
resistance when the needle passes through the cricothyroid membrane,
the needle has penetrated the other side of the tracheal cartilage.
h. Stabilize the needle with adhesive tape. Wrap a 6-inch to 8-inch strip of tape
around the needles once at the place where the needles exit the skin. Press the ends
of the tape around the needles so the needles are held in place and do not come off.
Keep the casualty's head relatively immobile.
j. Make preparations for a more permanent airway control. Use an
endotracheal intubation or tracheostomy if the airway needs to be artificially maintained
for a prolonged time.
k. The procedure may be varied by using a cannula-over-needle device. To do
this, remove the needle and allow the catheter to remain in place after it is positioned.