31605 Tracheostomy, emergency procedure; cricothyroid membrane

Name of the Procedure:

Tracheostomy, Emergency Procedure; Cricothyroid Membrane

Summary

An emergency tracheostomy through the cricothyroid membrane is a procedure performed to create an airway directly into the windpipe (trachea) through an incision in the neck. It is typically done when other forms of airway management are not possible or fail.

Purpose

This procedure is used in critical situations where the patient has a blocked or swollen airway, severe facial trauma, abnormal anatomy, or when conventional intubation cannot secure the airway. The goal is to ensure immediate and effective breathing by providing a direct airway.

Indications

• Severe airway obstruction
• Facial trauma preventing normal airway access
• Swelling or infections in the throat
• Emergency situations where other airway techniques fail

Preparation

• In emergency settings, preparation is minimal.
• Standard airway assessment and urgent vital sign monitoring.
• Cross-checking for any known allergies, particularly to local anesthetics.
• Pre-procedure briefing to the patient, if conscious and time permits.

Procedure Description

1. The patient is positioned supine with neck slightly extended, if possible.
2. The area over the cricothyroid membrane is sterilized.
3. Local anesthesia may be administered if the patient is conscious, but this is often skipped in extreme emergencies.
4. A vertical or horizontal incision is made over the cricothyroid membrane.
5. The membrane is punctured or incised to create an opening.
6. A tracheostomy tube or improvised airway device is inserted into the trachea through the created opening to maintain the airway.
7. The tube is secured and connected to a ventilation source.

Duration

Typically takes 2-10 minutes, depending on the situation's urgency and complexity.

Setting

Usually performed in emergency departments, intensive care units, or pre-hospital settings (like ambulances) during critical emergencies.

Personnel

• Emergency physicians or trauma surgeons
• Nurses and respiratory therapists
• Occasionally, paramedics in pre-hospital settings

Risks and Complications

• Bleeding and infection
• Damage to surrounding structures (vocal cords, esophagus)
• Long-term complications like scarring or airway obstruction
• Misplacement of the tracheostomy tube

Benefits

• Immediate airway access ensuring oxygenation and ventilation
• Potentially lifesaving when other methods fail
• Rapid stabilization of the patient's condition

Recovery

• Regular monitoring of the airway patency
• Care of the tracheostomy site to prevent infection
• Follow-up with ENT or respiratory specialists
• Gradual weaning off the tracheostomy tube once the underlying issue is resolved

Alternatives

• Endotracheal intubation (if feasible)
• Non-invasive ventilation methods (CPAP, BiPAP)
• Surgical tracheostomy (in less urgent settings)

Patient Experience

Patients may feel discomfort or pain during the procedure, especially if conscious and anesthesia is not used. Post-procedure, there can be mild discomfort, coughing, or difficulty speaking. Pain management and sedation are provided to ensure comfort.