Equipment 8-234 - Cricothyrotomy Kit

CMH EMS & MIH Protocols

Scope of Practice:

Registered Nurse
Paramedic

Indications:

This procedure is a last resort when all attempts at ventilating the patient have failed.
Protocol 2-044 - Airway: RSI

Contraindications:

None in an emergency setting and all other airway options have been exhausted.

Precautions:

Complications include hemorrhage from great vessel lacerations and damage to surrounding structures.
Constantly check ventilation by standard techniques.

Quick Trach II Procedure:

Prepare the device: Remove valve opener and completely evacuate the cuff with the included 10 ml syringe. Remove and fill syringe for inflating the cuff with 10 ml of air.
Prepare the patient: Hyperextend the Head of the patient. Locate the cricothyroid membrane by palpation of the depression between the thyroid and cricoids cartilage. Stabilize this point with forefinger and thumb for puncture.
Puncture the cricothyroid membrane and insert QuickTrach II until red stopper touches skin. An incision is not necessary.
Aspirate syringe to determine position of cannula. Aspiration of air indicates proper placement in trachea. If no air is aspirated, remove red stopper and advance slowly until air can be aspirated.
Remove red stopper.
Push cannula forward into the trachea and remove metal needle.
Inflate cuff with 10 ml of air.
Secure with foam neck tape.
Attach BVM with connector and verify placement with auscultation and Capnography.

Surgical Procedure:

If possible, call for MEDICAL CONTROL prior to attempting surgical cric.
Have Suction equipment ready.
Clean neck with antiseptic solution.
Stabilize larynx with thumb and index finger of one hand.
Palpate cricothyroid membrane.
Pull skin taut.
Make 2 cm VERTICAL incision at the cricothyroid membrane.
Puncture through the cricothyroid membrane horizontally.
Place Bougie with coude tip into trachea with a back-and-forth motion to feel tracheal clicking or carina.
Place ET tube or Shiley over Bougie just enough for cuff to be inside trachea.
Inflate cuff and secure tube.
Ventilate at 100% Oxygen.
Observe and auscultate for correct placement.
Confirm with Capnography.
Cover incision site with Occlusive dressing.

Citations:

Protocol 9-010 - References

Change Log:

Date	Link to previous version	Description of change
12/29/14	pdf	Added info from 8-330 (QuickTrach II) and removed 8-330.
09/16/15	pdf	Added comment that surgical cric must have physician orders.
07/04/20		Renumbered the section to allow for future additions.
08/07/20	pdf	Added content (without substantive modification) from old Section 8-070 - Cricothyrotomy Kit.
06/11/21	pdf	Moved to emsprotocols.online

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