critical care medicine
Surgical Airway
Cricothyrotomy
 Scalpel cricothyrotomy/FONA (front of neck airway) is typically used for emergency surgical access because it is faster and simpler than tracheostomy (see also How To Do a Percutaneous Cricothyrotomy ). The patient lies supine with the neck extended. After sterile preparation, the larynx is grasped with one hand while a blade is used to incise the skin, subcutaneous tissue, and cricothyroid membrane precisely in the midline, accessing the trachea. A hollow tube is used to keep the airway open. Unlike positioning for laryngoscopy or ventilation, the correct position for cricothyrotomy involves extending the neck and arching the shoulders backward. After sterile preparation, the larynx is grasped with the nondominant hand while a blade held in the dominant hand is used to vertically incise the skin, subcutaneous tissue, and cricothyroid membrane. A tracheal hook helps keep the space open and prevent retraction of the trachea while a small endotracheal tube (6.0 mm internal diameter [ID]) or small tracheotomy tube (cuffed 4.0 Shiley preferred) is advanced through the surgical site into the trachea. Complications include hemorrhage, subcutaneous emphysema, Pneumomediastinum , and 