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Surgery

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Thyroid & Adrenal

Question
64 out of 99
 

Cricothyroidotomy



A Should not be performed in children younger than 12 years of age.

B Should only be performed in patients who are not good candidate for a tracheostomy.

C Requires the use of an endotracheal tube smaller than 4 mm in diameter

D Is preferable to the use of percutaneous transtracheal ventilation.

Ans. A Should not be performed in children younger than 12 years of age. (REF. SABISTON SURGERY 18TH EDN CHP 13 PG 429)

a. A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or emergency airway puncture) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations.

b. Such situations are airway obstruction by a foreign body, angioedema, or massive facial trauma.

c. Cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated.

d. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine, and is associated with fewer complications.

e. However, while cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be a temporizing measure until a definitive airway can be established.

1. Indications

Can't intubate

Can't ventilate

Severe facial or nasal injuries (that do not allow oral or nasal tracheal intubation)

Massive midfacial trauma

Possible cervical spine trauma preventing adequate ventilation

Anaphylaxis

Chemical inhalation injuries

2. Contraindications are - Inability to identify landmarks (cricothyroid membrane)

Underlying anatomical abnormality (tumor)

Tracheal transection

Acute laryngeal disease due to infection or trauma

Small children under 10 years old (a 12–14 gauge catheter over the needle may be safer)

3. A cricothyrotomy is generally performed by making a vertical incision on the skin of the neck just below the "Adam's apple", or thyroid cartilage, then making another transverse incision in the cricothyroid membrane which lies deep to this point.

4. A needle cricothyotomy is similar, but instead of making a scalpel incision, a large over-the-needle catheter is inserted (12- to 14-gauge).

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