Ear, nose & throat · UKMLA & AKT
Emergency surgical airway (cricothyroidotomy)
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Cannot-intubate-cannot-oxygenate (CICO) - failed intubation AND failed oxygenation with all supraglottic devices; cricothyroidotomy is the rescue of last resort
- Severe maxillofacial/laryngeal trauma distorting anatomy
- Soft tissue oedema obliterating glottic view - anaphylaxis, angioedema, burns, Ludwig's angina, epiglottitis (only when intubation has already failed or is clearly impossible)
- Foreign body impacted at or above the glottis that cannot be removed
Cricothyroidotomy is NOT indicated simply because the airway is difficult or at risk. A patient with epiglottitis who is still maintaining their airway should undergo endotracheal intubation in a controlled setting - cricothyroidotomy is reserved for when intubation has failed AND the patient cannot be oxygenated.
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