Chapter 4 - Emergency surgical airways

Summary

This chapter presents a case to demonstrate the dire situation of can't ventilate, can't intubate (CVCI) in a patient who cannot breathe. The cricothyroid membrane is composed of fibroelastic tissue bordered by the cricothyroid muscles laterally, thyroid cartilage superiorly, and cricoid ring inferiorly. The fundamental difference between cricothyroidotomy techniques is how the procedure is approached and how the airway lumen is entered: either by needle puncture or blade incision. Needle puncture techniques are based on equipment originally developed for vascular access. The rate and nature of the complications associated with a cricothyroidotomy depend on the choice of technique, skill level of the operator, and patient factors. Surgical cricothyroidotomy is also inadequate for long-term ventilation and is frequently converted to a formal tracheotomy. Simulation is an important component of training and instruction in airway management, especially cricothyroidotomy because it is seldom performed.