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An easy cricothyrotomy approach: the rapid four-step technique.

A simplified 4-step cricothyrotomy technique is described. The procedure can be completed in < 30 seconds without use of suction or additional light source. The only equipment needed is a #20 scalpel, a tracheal hook with a large radius, and a cuffed tracheostomy tube. The 4 steps are: 1) palpation, 2) stab incision, 3) inferior traction, and 4) tube insertion. This streamlined method is simple and quick. Because the operator's body position and hand movements (steps 3 and 4) are similar to those in orotracheal intubation, there is a feeling of familiarity that enhances retention of the procedure. The steps are illustrated and 4 cases using this technique are reported. Since the hands at each step are stabilized on the patient and no special equipment is needed, this technique also may be ideal for the out-of-hospital environment.