09/03/2026
Today during lunch we were discussing our past clinical experiences. I wanted to document one of my memorable emergency procedures for my junior colleagues.
A patient was brought to the MDS at Vellankulum with severe airway obstruction following massive facial trauma due to a blast injury. The airway could not be secured through conventional intubation because of the extensive facial damage and obstruction. Therefore, an emergency surgical cricothyrotomy was performed to establish a patent airway.
Identification of the Cricothyroid Membrane
The cricothyroid membrane is located between the thyroid cartilage (Adam’s apple) and the cricoid cartilage.
Steps to locate it:
1. Palpate the thyroid cartilage.
2. Move the finger downward in the midline.
3. Feel a soft depression — this is the cricothyroid membrane.
Patient Position
• The patient was placed in a supine position.
• My nurse assisted by gently extending the neck to improve exposure of the airway.
• My team helped stabilize the larynx during the procedure.
Procedure
1. After identifying the cricothyroid membrane, I performed a surgical cricothyrotomy using a scalpel and artery forceps.
2. A vertical skin incision (about 3–4 cm) was made over the cricothyroid membrane.
3. Then a horizontal incision was made through the cricothyroid membrane.
4. Artery forceps were inserted to widen the opening.
5. A small endotracheal tube was passed through the opening into the trachea.
6. The cuff was inflated.
7. Tube placement was confirmed clinically.
8. Suction was performed and the patient was ventilated.
