Laryngotomy (emergency)

• preferable to tracheostomy as the cricothyroid membrane is more superficial than the trachaea
• needs suitable blade and tube (eg ball-point pen barrel)

Procedure:

• lie patient face up with support under the shoulders
• if possible, get someone to hold the patient's head on the midline, which greatly improves the chance of success
• feel for the Adam's apple (thyroid cartilage) - the cricothyroid membrane lies immediately below this and above the cricoid cartilage
• only extend the neck when ready to operate as the movement risks converting partial to total obstruction
• make a horizontal incision in the cricothyroid membrane and when the blood bubbles, twist the blade and introduce any available tube such as ball-point pen barrel
• one or more large bore cannulae may also be suitable

ref: H/B of Emergencies in Gen Pract 2e, N Lawrence et al