A rarely performed emergency airway. a cricothyrotomy
In season one, episode one of the TNT series The Cleaning Lady, a woman is accosted by a man and she strikes him in the trachea. He falls and can’t breathe. Something has happened to his larynx.
If he was in an operating room a skilled surgeon could have performed a tracheostomy. It’s an operation where a surgeon creates a hole through the neck, below the vocal chords. It allows air to enter the bronchus.
In The Cleaning Lady episode there wasn’t time for a tracheostomy—so the cleaning lady performed a crico-thyrotomy.
An onlooker asks: what did she do? How did she do that?
A friend answers: she’s a doctor.
The cleaning lady is a Cambodian doctor. Her son has a rare medical condition and doctors in her country don’t know how to fix him. The woman doctor brought her son to the U.S. illegally in the hope that she can get him medical care here.
The operation she performed, the cricothyrotomy is rarely performed and is considered a last resort. It becomes an option when a person cannot breathe and can’t be intubated. I learned about it in medical school but never saw one performed.
Background: Air moves through our mouths and noses, past the pharynx (back of the throat), and between open vocal chords. Then it travels through the trachea “the cartilaginous tube that connects the larynx to the bronchi of the lung,” and it enters the lungs.
On occasion an injury occurs that blocks a person’s trachea, and rarely something causes the vocal chords to go into spasm. When the air can’t get to the lungs the person can’t breathe or speak. “At times on lookers will hear a high pitched sound when the person breaths in. The sound is called stridor.
“In most cases, episodes of laryngospasm end after a minute.”
The following is from an ‘Emergency Surgical Airway” video on the web:
There’s a small membrane in the neck. It’s the size of a dime and has no blood vessels. If a blade cuts through it correctly, the blade will not slice open an artery or a vein. The neck won’t start bleeding.
The membrane is located just below the thyroid cartilage and just above the upper trachea. In the YouTube video the surgeon is wearing sterile gloves. His first step “is to identify the location of the membrane with landmarks. The thyroid cartilage is located in the upper neck. It can be identify by its protruding bony ridge. “Your target is just below this landmark. You can feel a small indent. After locating the site, tension should be placed on the skin and the trachea should be secured.” The doctor then uses a scalpel and makes a vertical incision, thereby avoiding nearby blood vessels. Then he pierces the membrane with his gloved finger. He puts his finger in the hole and keeps it there until he has inserted a tube—like a large straw. Then air starts moving through the tube.
It’s a last resort and I hope you never have to attempt to do one.
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