Operational Medicine 2001
Cricothyroidotomy

Often, the safest and fastest method to establish a surgical airway is to perform a cricothyroidotomy.

In this procedure, the cricothyroid membrane is opened to allow air to pass through into the trachea..

The cricothyroid membrane is the soft spot just below the Adam's apple (thyroid cartilage) and just above the cricoid cartilage. In men, this is easily identified by running your finger down the center of the neck. Just beyond the Adam's apple is a small, soft indentation about the width of your finger. This is the cricothyroid membrane.

The thyroid cartilage (Adam's apple) in women is not usually as prominent as it is in men. It is easier to find their cricothyroid membrane by sliding your finger up the midline of the neck to the first hard bump. That is the cricoid cartilage. Above it is the cricothyroid membrane (your target), and above the membrane is the thyroid cartilage.

Practicing identifying the cricothyroid membrane in your own neck, and in other personnel. Then, in an emergency, you will have no difficulty finding it.

To perform an emergency cricothyroidotomy, you need a sharp instrument, such as a:

• Scalpel

• Pocket knife

• Scissors

• Razor blade

• Sharp edge of a tin can

• Broken glass

Ideally, this procedure is performed by well-trained and experienced medical personnel, using sterile technique and instruments designed for this purpose. In other than ideal conditions, speed is more important than sterile technique, special instruments or experience.

In an operational setting, if the casualty needs a surgical airway, go ahead an do it, and do it quickly. Some of the most successful airway rescues have been performed by inexperienced, minimally-trained personnel, who have never done this before.

There typically won't be time for any anesthetic, but that's not normally and issue since the people on whom you would be doing this procedure will be unconscious.

Bleeding usually isn't a big problem. There are no large blood vessels either in the skin or beneath the skin in this area.

1. Identify the cricothyroid membrane with your index finger.

2. Make a transverse incision using any available sharp object, directly over the cricothyroid membrane. The incision should be about an inch long.

3. Once through the skin, feel with your index finger for the soft, compressable cricothyroid membrane.

4. Take your sharp object and push it straight down through the cricothyroid membrane. There will be a distinct "pop" as you open the trachea. Don't worry about going too deep. The far side of the trachea at this point is made of very tough cartilage and it's not too easy to go all the way through it.

5. Once through the membrane, withdraw your sharp instrument and replace it with a hollow tube to keep the airway open. 

Ideally, this hollow tube would be an endotracheal tube, but any tube-like structure will work fine. Examples include:

• Ball point pen barrel

• Nail clipper

• Two keys

• One key turned sideways

• Bent paper clip

Whatever device you use to keep the airway open, try to find some adhesive tape to hold it in place, without obstructing air flow.

An emergency cricothyroidotomy can be left in place for up to 72 hours, but after that, it should be replaced by a tracheostomy, placed lower in the trachea by trained surgeons.

This section was developed from A1701-70-0750V "Emergency Airway." Health Sciences Media Division, US Army Medical Department C&S, Fort Sam Houston, Texas

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001
Health Care in Military Settings

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