Cricothyrotomy (scalpel-finger-bougie technique)

Steps

1. Position yourself on the side of the patient that corresponds to your dominant hand (right side if right-handed, left side if left-handed).

2. Extend the patient’s neck if possible.

3. Prepare the anterior neck with antiseptic.

4. Stabilize the larynx with your non-dominant hand and locate the cricothyroid membrane with your index finger.

5. Rest your dominant hand on the patient’s sternum for stabilization.

6. Make a 3-5 cm vertical midline incision through the skin and subcutaneous tissues from the thyroid to the cricoid cartilage. Bluntly dissect as needed with your non-dominant index finger.

7. Palpate the membrane again.

8. Make a horizontal incision through the cricothyroid membrane, first in one direction and then in the other.

9. Insert the tip of your non-dominant index finger into the trachea to further dilate the hole.

10. Pass the bougie along your finger into the trachea. Confirm that you are in the trachea by tracheal rumble and holdup at the carina.

11. Pass a 6.0 ET tube or tracheostomy tube over the bougie until the cuff is inside the trachea.

12. Remove the bougie.

13. Inflate the cuff.

14. Connect to a bag-valve mask and begin ventilation.

15. Secure tube.