laryngotomy (emergency)
Last reviewed 01/2018
- preferable to tracheostomy as the cricothyroid membrane is more superficial than the trachaea
- needs suitable blade and tube (eg ball-point pen barrel)
Procedure:
- lie patient face up with support under the shoulders
- if possible, get someone to hold the patient's head on the midline, which greatly improves the chance of success
- feel for the Adam's apple (thyroid cartilage) - the cricothyroid membrane lies immediately below this and above the cricoid cartilage
- only extend the neck when ready to operate as the movement risks converting partial to total obstruction
- make a horizontal incision in the cricothyroid membrane and when the blood bubbles, twist the blade and introduce any available tube such as ball-point pen barrel
- one or more large bore cannulae may also be suitable
ref: H/B of Emergencies in Gen Pract 2e, N Lawrence et al