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Emergency airway puncture - series

Normal anatomy

The larynx is a tubular structure in the neck, through which air passes to the lungs. The thyroid and cricoid cartilage form the narrowest section of this airway.

Indications

The area of the larynx bounded by the thyroid and cricoid cartilage is a frequent site for obstruction, either by swallowed foreign bodies or abnormal tissue growths. A cricothyrotomy is an emergency procedure that relieves an airway obstruction until formal surgical placement of a breathing tube (tracheostomy) is performed.

Incision

If the situation is acute, a hollow needle is inserted into the throat, just below the Adam's apple (thyroid cartilage). This is called a needle cricothyrotomy. More frequently, a small incision is made in the skin over the cricothyroid membrane, and another incision is made through the membrane between the cricoid and thyroid cartilage.

Procedure

A tube that enables breathing is inserted through the incision.

Aftercare

Cricothyrotomy is generally followed by a surgical tracheosotomy, if there is need for a prolonged use of a breathing tube. Removal of breathing tubes from both a cricothyrotomy and tracheostomy is usually followed by prompt healing of the incision site.

Review Date: 10/6/2022  

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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