Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVII: Wounds and Injuries of the Neck

Technique for Cricothyroidotomy

United States Department of Defense

As previously mentioned, in extreme airway emergencies or When the medical officer has had no experience with endotracheal intubation or tracheostomy or lacks the appropriate equipment, a cricothyroidotomy should be performed. The inferior border of the large, prominent thyroid cartilage is identified by palpation. The cricoid cartilage, which is the smaller protuberance just below, is similarly identified. The taut membrane which separates the thyroid cartilage from the inferiorly located cricoid cartilage is relatively superficial. After adequate skin incision, the space between these cartilages, which is avascular, is incised transversely and the tracheal lumen is readily entered through the incision. A small endotracheal tube, no. 5 or no. 6, should be rapidly inserted and the balloon inflated. If no tube is available, a clamp may be used temporarily to keep the incision open. The cricothyroidotomy should be relied upon for only 48 hours. If airway management is anticipated for greater than 48 hours a conventional tracheostomy should be accomplished under controlled circumstances as soon as possible.

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Operational Medicine 2001

Health Care in Military Settings

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