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    Surgical Airway Management

    Critical Care / Resuscitation, Respiratory

    Last Updated Dec 14, 2018
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    Context

    • Once the decision to perform a surgical airway has been made it is essential that the procedure be performed in a deliberate and efficient manner.
    • It is our recommendation and that of other airway practitioners and societies that the “bougie cric” or bougie cricothyrotomy technique is the standard method of surgical airway establishment in the resuscitative emergency airway management
    • For details of performing the procedure see procedural video: cricothyrotomy.

    Management

    Procedure:

    1. Stabilization of the thyroid cartilage,
    2. Confirmation of the cricothyroid membrane,
    3. A deep vertical incision over above and below the cricothyroid membrane,
    4. Penetration of the cricothyroid membrane (and enlargement) and
    5. Passage caudally of the bougie
    6. Insertion of the ET tube over the bougie
    7. Cuff inflation and confirmation of tube placement as with any tracheal intubation with endtidal-CO2 reading and assessment of oxygenation.

     

    • Similar videos exist online, but the procedure must be practised and standardized and the associated equipment must be readily available and optimally packaged and ready for use in the emergency department.

     

    Equipment:

    • a bougie,
    • a large blade (ie. #10, 20, 21) and
    • a number 6.0 endotracheal tube.
    • Always make sure your bougie fits your tube prior to the procedure.

    Quality Of Evidence?

    Justification

    Case series and consensus opinion by airway experts.

    Moderate

    Related Information

    OTHER RELEVANT INFORMATION

    1. AIME Airway procedural videos: http://aimeairway.ca/video-39-s


    2. Scott Weingart. EMCrit Podcast 131 – Cricothyrotomy – Cut to Air: Emergency Surgical Airway. EMCrit Blog. Published on August 26, 2014. Accessed on July 25th 2017. Available at [https://emcrit.org/emcrit/surgical-airway/].

      Including:
      https://emcrit.org/emcrit/wearable-cric-trainer/,
      https://emcrit.org/emcrit/surgical-airway/,
      https://emcrit.org/emcrit/bougie-aided-cric/


    3. Airway Management in Emergencies – Open-access online textbook from www.aimeairway.ca.


    Relevant Resources

    RELEVANT CLINICAL RESOURCES

    View all Resources

    RELEVANT VIDEO

    00:59

    Cricothyrotomy

    View all Videos

    RESOURCE AUTHOR(S)

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