- Adult failed airway.
- Management of an airway when standard airway procedures cannot be performed or have failed in a patient greater than or equal to 12 years old.
- Have suction and supplies available and ready.
- Locate the cricothyroid membrane utilizing anatomical landmarks.
- Prep the skin with an antiseptic solution.
- Attach a 5 mL syringe to an 18 G - 1 ½-inch needle.
- Insert the needle (with syringe attached) perpendicularly through the cricothyroid membrane with the needle directed posteriorly.
- During needle insertion, gentle aspiration should be applied to the syringe. Rapid aspiration of air into the syringe indicates successful entry into the trachea. Do not advance the needle any further. Attach forceps and remove syringe.
- With the needle remaining in place, make a 1-inch vertical incision through the skin and subcutaneous tissue above and below the needle using a scalpel. Using blunt dissection technique, expose the cricothyroid membrane. This is a bloody procedure. The needle should act as a guide to the cricothyroid membrane.
- With the needle still in place, make a horizontal stabbing incision approximately ½ inch through the membrane on each side of the needle. Remove the needle.
- Using (skin hook, tracheal hook, or gloved finger) to maintain surgical opening, insert the cuffed tube into the trachea. (Cric tube from the kit or a 6.0 endotracheal tube (ETT) is usually sufficient).
- Inflate the cuff with 5-10 mL of air and ventilate the patient while manually stabilizing the tube.
- All of the standard assessment techniques for insuring tube placement should be performed (auscultation, chest rise & fall, end-tidal CO2 detector, etc.). Esophageal bulb devices are not accurate with this procedure.
- Secure the tube to the patient’s face.
- Document ETT size, time, result (success), and placement location by the centimeter marks. Document all devices used to confirm initial tube placement and after each movement of the patient.
- Document the procedure, time, and result (success) on/with the patient care report (PCR).
- It is required that the airway be monitored continuously through waveform capnography and pulse oximetry.
- Complete an airway evaluation form with all intubations.
THIS PROTOCOL IS FOR THOSE PARAMEDICS EXPRESSLY APPROVED BY MD. LUTZ TO PERFORM THIS SKILL. NO OTHER PARAMEDIC CAN PERFORM THIS SKILL EVEN WITH DIRECTION FROM ON- LINE MEDICAL CONTROL