Ear, nose & throat · UKMLA & AKT
Emergency surgical airway (cricothyroidotomy)
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise emergency surgical airway (cricothyroidotomy) — the full SA Note notes add investigations, management, complications and 10 practice questions.
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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