Cricothyrotomy
(2) Cricothyroid ligament
(3) Cricoid cartilage
(4) Trachea
(A) Location of the cricothyrotomy
(B) Location of the tracheotomy
A coniotomy (synonymous: "Konicotomy" or "Krikothyreotomy" - from Greek. Κωνος = cone / κρίκος = ring / θυρεός = shield / τομή = incision , colloquially also called tracheal incision ) is understood to mean the acute opening of the airways at the level of the larynx Choking hazard. It is an emergency medical life-saving measure that is rarely used and only used as a last resort .
In emergency medicine , it is carried out as part of airway management when the airways are obstructed above the larynx and breathing cannot be secured otherwise (e.g. through intubation or ventilation ) and there is a risk of suffocation . It is an emergency medical procedure and by no means a layperson's first aid measure . It is the first choice in a cannot-intubate-cannot-ventilate situation, i.e. when ventilation with a mask (in the broadest sense also a laryngeal mask or similar) or intubation is not possible.
The cricothyrotomy is only a temporary procedure for temporarily oxygenating the blood to prevent death from lack of oxygen. To prevent complications, the patient is intubated or tracheostomized as soon as possible after a cricothyrotomy .
Procedure
Access to the respiratory tract is established at the level of the larynx. The membrane ( ligamentum conicum , the free area of the ligamentum cricothyroideum ) between the cricoid and thyroid cartilage is opened.
In a surgical cricothyrotomy , the skin over the cricothyroid membrane is incised lengthways with a sharp scalpel about 3 cm (see figure, flashing red line ). The actual membrane is then palpated below the Adam's apple (prominentia laryngea) using a scalpel (a scalpel with a pointed blade no.11 ) to be severed horizontally to reveal a possible variety, the arteria thyreoidea ima (additional vessel from the aortic arch to supply the thyroid ), not to hurt. An endotracheal tube (approximately the size of Charrière (Ch.) 20, i.e. with an outer diameter of 6.9 mm and an inner diameter of 5.0 mm) is then carefully advanced into the opening that is created , through which ventilation is possible. The tube is best pushed onto a guide wire using lubricant. It is advisable to lean your head back before the procedure, i.e. to bend backwards. The tube is chosen to be smaller than that used for intubation.
Mostly, however, puncture methods are used for tracheal puncture (puncture of the windpipe ). The ligamentum conicum is punctured using a metal cannula with a diameter of about 4 mm . A trocar may be used or the Seldinger technique may be used, whereby the membrane is punctured with a thin cannula, through which a guide wire is then inserted. After removing the cannula, the ventilation tube can be pushed in over the guide wire, through which the patient can then be ventilated. There are also ready-made systems for this, such as the Quicktrach coniotomy set.
literature
- Mutzbauer, Keul, Bernhard, Völkl, Gries: Invasive Techniques in Emergency Medicine - IV. Cricothyrotomy in Emergency Medicine. In: The anesthesiologist. Volume 54, No. 2, 2005, pp. 145-154.
- SQ Tighe: Surgical Cricothyroidotomy. Difficult Airway Society Annual Meeting, Glasgow 4-5 December 2003, proceedings.
- R. Vanner: Large Cannula Techniques for Emergency Cricothyrotomy. Annual Meeting Difficult Airway Society, Glasgow 4-5 December 2003, Proceedings.
Individual evidence
- ↑ Marek Humpich, Christian Byhahn: Airway Management - Invasive Airway Management Update 2011 Invasive airway management update 2011. AINS - Anesthesiology · Intensive Care Medicine · Emergency Medicine · Pain Therapy; Issue 09 (2011), pp. 608–616.
