This procedure must be performed within 4 minutes.
a. Place the casualty in the supine position with the neck straight and slightly
hyperextended. If you suspect that a casualty has a cervical injury, do not hyperextend
the neck. Place a large, rolled-up towel under the casualty's neck or between the
shoulder blades so the airway is straight.
b. Locate the cricothyroid space. To do this, palpate the thyroid cartilage
(Adam's Apple) with the index finger of one hand. Slide the finger down until you feel
the cricothyroid space. (The cricoid cartilage is next).
c. Move the finger upward to the cricothyroid space and cleanse the area.
(Cleansing the area may not be possible in a field situation.)
d. Raise a tent of skin overlying the cricothyroid space, using your index finger
e. With the cutting instrument in your other hand, make a one and one-half inch
horizontal incision through the tented skin down to the cricothyroid space.
f. Reidentify the cricothyroid space by touch and sight.
g. Stabilize the larynx with one hand and make a 1 1/2-inch horizontal
incision through the elastic tissues of the cricothyroid membrane.
h. Insert the dilator through the opening.
i. Separate the blades of the dilator to make a larger opening. A rush of air
through the opening may be noted.
j. Insert the end of the cannula between the blades of the dilator. The cannula
should be in the trachea and directed toward the lungs.
k. Secure the cannula in place to reduce the movement in the opening and to
keep the casualty from inhaling the cannula. You may perform mouth to cannula
resuscitation if necessary. Inserting the cannula may stimulate reflex coughing. This
may aid in clearing the airway, but it is still important to secure the cannula properly.
l. Suction this way. Insert the suction catheter 4 to 5 inches into the cannula.
Then, apply suction only when you are withdrawing the catheter. One cc of saline
solution may be introduced in the airway to loosen secretions and make suctioning
easier. Always allow the casualty to take breaths between efforts to suction.