C/I: less invasive means, < 8 yo.
Equipment: Yanker suction, bougie preloaded in ET tube (6.0 tube), hemostat/needle driver, any scalpel (11 blade).
Anatomy: Space between thyroid cartilage and cricoid cartilage. Feeling for Adam’s apple and go below it (60% accurate).
Ultrasound: thyroid and cricoid cartilage actually are full of fluid so they appear black on ultrasound. White line is trachea lining.
Use non-dominant hand and hold the area. First incision is up/down (universal sign for death is across). Small incision until you get to the trachea. Then while scalpel is still in place, use hemostat to keep area open, then slide bougie thru the hole.
ET tube: cut it just above the balloon and then re-cap.
Complications: losing the hole, aspiration, blood in eyes, arterial hemorrhage.
Critical Procedures: Canthotomy and Cricothyrotomy, Mak Moayedi, The Crashing Patient Conference 2015.