Cricothyrotomy

Under a cricothyrotomy ( synonym: " Konikotomie " or " Krikothyreotomie " - from the Greek κωνος = cone / κρίκος = ring / θυρεός = sign / τομή = average, colloquially also incorrectly referred tracheotomy ) refers to the opening of the airways in the amount of the larynx in acute suffocation. She is a medical emergency life-saving measure that is rarely and only as a last resort to use.

In emergency medicine it is carried out in the context of airway management if the airway is moved above the larynx and breathing differently (eg intubation or ventilation) can not be secured, thereby threatening suffocation. It is an emergency medical procedure and by no means a measure of the laity in the context of first aid. It represents the agent of first choice in a cannot- intubate - cannot- ventilate situation when neither ventilation with a mask ( in the broadest sense including laryngeal mask, etc. ) nor intubation is possible.

The Cricothyrotomy represents only a temporary procedure for temporary oxygenation of the blood to prevent death from lack of oxygen. To prevent complications, the patient is intubated or a tracheostomy as soon as possible after a cricothyrotomy.

Method

Access to the respiratory tract is made at the level of the larynx. The membrane ( ligament conicum, the vacancy of the cricothyroid ligament ) opened between the cricoid and thyroid cartilage.

In the surgical cricothyrotomy the skin over the membrane cricothyroidea with the sharp scalpel longitudinally incised about 3 cm (see illustration, flashing red line). After this, the actual membrane after digital identification, with a scalpel ( a scalpel with a sharp blade No. 11) cut horizontally. The resulting opening in an endotracheal tube is then ( approximately the size Charrière ( Ch ) 20, that is, with an outer diameter of 6.9 mm and an inner diameter of 5.0 mm) advanced carefully through which a ventilation is possible. The tube is most pushed using lubricant on a guide wire. It is advisable to reklinieren the head on the neck before surgery, so to bend backwards. The tube is chosen smaller than in the intubation.

Mostly, however, puncture procedures are applied. This is punctured by means of a metal needle having a diameter of about 4 mm, the ligament conicum. Thereby, a trocar may be inserted or applied, the Seldinger technique, wherein the membrane is punctured with a fine needle through which a guide wire is then introduced. After removal of the cannula can be inserted over the guidewire of the breathing tube through which the patient may then be ventilated. For this, there are also ready-made systems such as the Quicktrach - Koniotomieset.