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Procedure Guidelines 9.10
- If unable to ventilate and airway not patent, perform Cricothyrotomy, as listed on line 5, page 2-7 in the Practice Parameters.
- When an airway is needed and intubation is unsuccessful.
- Children under 12 years old.
- Known bleeding disorder and/or anticoagulant therapy.
- Unable to locate landmarks.
- #11 scalpel blade with handle.
- Needle nose hemostats.
- 5.0 to 7.0 mm endotracheal tube, cut above pilot balloon.
- Antiseptic swabs.
PROCEDURE: (refer to illustrations):
- Place the patient in a supine position with the neck in a neutral position.
- Palpate the thyroid notch, cricothyroid membrane, and the sternal notch for orientation. Gather equipment.
- Prepare site with Antiseptic swabs.
- Stabilize the thyroid cartilage with thumb and 3rd finger of hand. Stretch skin taut.
- Make a superficial transverse skin incision over the cricothyroid membrane. Carefully puncture through the membrane and maintain site with tip of gloved index finger.
- Insert the scalpel handle into the incision and rotate 90 degrees to open airway OR insert hemostats to enlarge opening for passage of tube.
- Insert cuffed endotracheal tube into the cricothyroid membrane incision directing the tube distally into the trachea.
- Inflate the cuff and ventilate the patient with BVM.
- Observe breath sounds and auscultate the chest for adequate ventilation.
- Secure the endotracheal tube.
- Continue to ventilate and observe chest rise.