Possession of conicotomy technique can be a life-saving chance for asphyxiation in a patient. Of course, this is simple, and it would be strange to hope that a person without a medical education will be able to master it. But still, this information may be useful.
What are we talking about
The term "conicotomy" refers to emergency medicine. This is the name of the operation associated with the dissection of the larynx between the cricoid and thyroid cartilage. Otherwise, it can be called a dissection of the conical ligament, which is located between these cartilages. Doctors often call the ligament membrane. It consists of elastic fibers, the swelling of which leads to asphyxiation.
Sometimes the term "conicotomy" is replaced by synonyms - "coniotomy" or "cricothyrotomy". However, the technique for performing conicotomy does not change from this.
Indications for
Denote the main cases in which a conicotomy is performed. Indications for surgery are acute cases of asphyxiation. The causes of asphyxia can be as follows:
- swelling of the tissues of the larynx against the background of infectious processes;
- rapid allergic reaction;
- a sharp spasm from exposure to chemicals or physical interference;
- foreign body contact;
- complication of intubation;
- wounds incompatible with laryngoscopy;
- neoplasms in the upper respiratory tract.
Contraindications to conicotomy
Since conicotomy is an emergency operation, there are almost no contraindications to its implementation. It is carried out by both adults and children over 8 years old. If the need for manipulation arises earlier than this age, then the technique for performing conicotomy will vary significantly. Experienced doctors know and take this into account.
Tools and materials used for conicotomy
An emergency conicotomy kit must be in any medical facility and emergency teams.
Usually it includes:
- surgical scalpel ;
- permissible type of retractor;
- tubes for tracheotomy;
- special wide needle or vascular catheter (for puncture of menbrana);
- long tweezers;
- syringe for anesthesia;
- scissors;
- dressing and fixing material (bandage, cotton wool band-aid).
Many well-known companies produce special kits for conicotomy. For example, the Portex kit includes a special shortened scalpel, an elastic conductor with a tracheal cannula, a connector and a catheter. A Cook Crit. Care includes:
- 5 ml syringe;
- puncture needle for the trachea;
- conductor;
- scalpel and Melker device (pointed expander with cannula).
In an emergency, the doctor can conduct a conicotomy with a sharp knife, instead of a scalpel, and replace the tracheotomy tube with a household rubber or plastic tube. You can even use a cylinder from a ballpoint pen. Despite the risk of injury, this may be the only chance to save the patient.
Technique for adults
The victim (patient) lies on his back, a roller is placed under the shoulder blades, his head is thrown back. The doctor treats the skin of the neck with an antiseptic, puts on gloves and does local anesthesia.
Further, it operates according to the following algorithm:
- The index finger finds the gap between the cricoid and thyroid cartilage.
- Presses the thyroid cartilage so that it does not move during the manipulation.
- With the other hand, he takes a scalpel and performs a transverse incision. The length of the incision is approximately 2 cm, it should cut through the skin and ligament in the above place.
- The hole formed is stretched by the expander (for the trachea or Trousseau). Next, a tracheotomy tube is inserted into the hole.
- After fixing the tube, the retractor is removed and the oxygen mixture is connected.
If a puncture is performed instead of an incision, which produces a mild effect on an adult, then a special needle or vascular catheter is inserted into the trachea. After insertion, the needle is necessarily removed from the vascular catheter; it blocks the flow of air.
Features of children's conicotomy
Conicotomy is not recommended for children under eight years of age because of the high probability of damage to the thyroid gland, carotid artery or jugular vein. For children's conicotomy, the doctor will use a thick needle, not cutting, but piercing the skin and membrane. The needle must be inserted at an angle of 45 ° along the trachea.
Possible complications
Although conicotomy is the most affordable and safest way to restore airway patency, complications can occur.
Statistical calculations give different data on the complications of conicotomy. Some sources claim that they make up almost 40%. The most common are:
- bleeding due to vascular damage;
- cartilage injury;
- thyroid wounds;
- esophageal tissue injury;
- incorrect installation of the tube (out of the lumen or in the submucous layer of the trachea);
- injury to the vocal cords.
If the technique for performing a conicotomy is impaired or the manipulation is not done well, the patient may die.