a blog series on emergency medicine procedures
PEDIATRIC POINTS
In our last 2 posts (the cricothyrotomy part 1 and the cricothyrotomy part 2), we focused on adults. That is because the open surgical airway is often contraindicated in children as we discuss below, and there is an alternative method depending on age.
PEARL: the cricothyroid membrane in children is significantly different…
From Roberts and Hedges’ Clinical Procedures in Emergency Medicine, 6th ed, 2013
- Smaller
- More anterior
- Funnel shape
- Structures like the larynx are more difficult to stabilize
PEARL: in the majority of cases, open surgical cric on children is contraindicated
- Children younger than 10-12 years old should not have an open surgical cricothyrotomy according to most emergency medicine textbooks
- Why: risk of injuring important structures due to the anatomical differences listed above
- Instead, if a non-invasive airway is impossible, perform a percutaneous needle cricothyrotomy
PEARL: what type of ventilation to use
- Bag ventilate if the patient is < 5 years old (risk of barotrauma with jet)
- Jet ventilate if the patient is greater than 5 years old
SUMMARY
Child < 10-12 years old, cannot intubate, cannot ventilate, and rescue airway devices not working? Perform percutaneous needle cricothyrotomy (see below).
< 5 years old? Bag ventilate.
> 5 years old? Jet ventilate.
TECHNIQUE
- Percutaneous needle puncture of the cricothyroid membrane
- Translaryngeal ventilation (PTLV) by jet insufflation OR bag insufflation (age dependent)
From Roberts and Hedges’ Clinical Procedures in Emergency Medicine, 6th ed, 2013
From Beck et al, Academic Emergency Medicine, Percutaneous Transtracheal Jet Ventilation, 2011
Please also view these resources from our own Brown faculty!
Dr. Valente Sim Video
Procedurettes Junior Jet Job
PLEASE SHARE ANY PEDIATRIC POINTS ON THE CRICOTHYROTOMY IN THE COMMENTS SECTION!
Textbook References
Hebert R, Bose S, Mace. Cricothyrotomy and Percutaneous Translaryngeal Ventilation. Chapter 6, 120-133.e2. In: Roberts J, et al. Roberts & Hedges’ Clinical Procedures in Emergency Medicine. 6th Saunders; 2013.
Smith M. Surgical Airway Management. In: Tintinalli JE, et al. Tintinalli’s Emergency Medicine. 7th ed. New York: McGraw-Hill; 2011.
Walls RM: Airway. In Marx JA, Hockberger RS, Walls RM: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 6th ed, vol. 1. Philadelphia, Elsevier, 2006, pp 2-25.
Image References
Hebert R, et al. Cricothyrotomy. In: Procedures Consult. Elsevier; 2008.
Authorship
Faculty Reviewers: Gita Pensa MD and David Lindquist MD
Author: Jonathan Ameli MD