LEVEL: Paramedic

This procedure may be performed on any patient with:
A.  Total airway obstruction by any BLS or ALS procedures, OR
B.  Inability to be adequately ventilate with any provider level emergency care procedures prior to the attempt.

A.  Inability to identify landmarks (cricothyroid membrane)
B.  Underlying anatomical abnormality (tumor)
C.  Tracheal transection
D.  Acute laryngeal disease due to infection or trauma

- Pediatric needle cricothyroidotomy is by Telemetry Physician order only.
- You MUST use a 14 gauge over-the-needle catheter attached to a 10 cc syringe or commercial cricothyroidotomy device.

Key procedural considerations:
A.  Position patient supine (if possible), hyperextending the head.
B.  Locate cricothyroid membrane and clean site thoroughly.
C.  Stabilize cricoid and thyroid cartilages with one hand.
D.  Insert needle/catheter at a 45º angle; gently aspirate with attached syringe while inserting.
E.  When syringe is able to aspirate air, stop advancing needle.
F.  Continue to advance catheter downward and withdraw needle.
G.  Ventilate the patient allowing an inspiratory/expiratory ratio of 1:3.
H.  Secure the device and auscultate lung fields.
I.  Apply a 3-way stopcock to the end of the hose assembly when utilizing a Transtracheal Jet Insufflator.