The primary indication to create a surgical airway is the need for an airway for a
patient who cannot be intubated. Cricothyrotomy, creation of a surgical airway, is the
incision through the skin and cricothyroid membrane to secure a patient airway for
emergency relief of upper airway obstruction. The word cricothyroidotomy is another
name for this surgery. The two types of cricothyrotomy are needle cricothyrotomy and
surgical cricothyrotomy. Needle cricothyrotomy is an acceptable, alternative method to
the surgical route. This method is preferable in an emergency situation for a child under
12 years of age.
a. Needle Cricothyrotomy Procedure. Place the patient in the supine position
and follow this procedure:
Identify the cricothyroid membrane like this:
(a) Stabilize the larynx with the thumb and middle fingers of one hand.
Palpate for the V notch (Adam's apple) with the index finger.
Prepare the area quickly with povidone-iodine swabs.
(3) Puncture the skin over the cricothyroid membrane with a number14
gauge over-the-needle catheter. This catheter should be connected to 6-12 milliliter
Figure 3-7. Inserting the needle into the cricothyroid membrane.