TYK409
In the evaluation of a 1 month old traumatically injured patient, you recognize significant facial trauma. Which of the following is NOT true regarding needle cricothyrotomy in the neonate?
a) The cricothyroid membrane can approximate 2 mm in cephalad-caudal length, as compared to the adult length of 10 mm; this restricts the size of airway that can be placed
b) In the presence of complete upper airway obstruction, oxygenation and ventilation through a needle cricothyrotomy can lead to a significant increase in intrathoracic pressure
c) A breathing circuit cannot be directly attached to an angiocatheter that has cannulated the airway
d) Adequate ventilation is likely via a successfully placed needle cricothyrotomy
Answer
Answer d. The emergent needle cricothyrotomy is principally targeted at adequate oxygenation, and ventilation can be challenging especially in small caliber airways. Most practitioners feel that the size of the cricothyroid membrane precludes successful management with an open cricothyrotomy in neonates, as an adequate artificial airway size cannot pass between the thyroid and cricoid cartilages. For needle cricothyrotomy, the angiocatheter must be connected via an adapter to the breathing circuit. Complete upper airway obstruction is not an absolute contraindication to needle cricothyrotomy, but the practitioner should have a high index of suspicion for air trapping because the expected exit path of insufflated air is via the upper airway.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.