RT Book, Section
A1 White, Steven J.
A1 High, Kevin
A1 Stack, Lawrence B.
A1 Levitan, Richard M.
A2 Knoop, Kevin J.
A2 Stack, Lawrence B.
A2 Storrow, Alan B.
A2 Thurman, R. Jason
SR Print(0)
ID 1181051834
T1 Scalpel-Finger-Bougie Cricothyrotomy
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181051834
RD 2024/04/20
AB Cleanse  and  anesthetize  the  skin  if  the  clinical  situation  allows  (see  Video  22.11).If  right  hand  dominant,  stand  on  the  patient’s  right  side  (see  Fig.  22.82).With  the  nondominant  hand,  identify  the  thyroid  cartilage  and  stabilize  with  the  long  finger  and  thumb  (see  Fig.  22.83).With  the  nondominant  index  finger,  identify  the  cricothyroid  membrane  and  cricoid  cartilage  (see  Fig.  22.84).With  the  dominant  hand,  make  a  vertical  (north  to  south)  incision  through  the  skin  from  the  bottom  of  the  thyroid  cartilage  to  the  top  of  the  cricoid  cartilage  (see  Fig.  22.85).With  the  nondominant  hand  index  finger,  through  the  north  to  south  incision,  reconfirm  the  cricothyroid  membrane  (see  Fig.  22.86).Using  a  stab  incision,  incise  the  cricothyroid  membrane  horizontally  (east  to  west)  (see  Fig.  22.87).Rotate  the  scalpel  180  degrees  to  fully  extend  the  cricothyroid  membrane  incision  (see  Fig.  22.88).Firmly  place  the  dominant  hand  small  finger  into  the  trachea  directed  caudally  and  blunt  dissect  to  allow  passage  of  an  ETT  (see  Fig.  22.89).Place  a  bougie  in  the  trachea  directed  caudally  (see  Fig.  22.90).Insert  a  6.0-mm  ID  ETT  over  the  bougie  and  into  the  trachea  until  the  top  of  balloon  is  at  least  3  cm  below  the  level  of  the  skin  (see  Fig.  22.91).Inflate  the  ETT  cuff  (see  Fig.  22.92).Remove  bougie  while  holding  ETT  in  the  trachea.Initiate  ventilation.Confirm  tube  placement  with  end-tidal  carbon  dioxide  detector.Secure  ETT  using  institutionally  accepted  method.