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Subject: Percutaneous Cricothyrotomy
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Melker emergency cricothyrotomy catheter set (Cook Medical), which includes these items:
Tapered curved dilator
Polytetrafluoroethylene (Teflon, PTFE, TFE) coated catheter needle
Guidewire with flexible tip
Inability to perform oral or nasal endotracheal intubation
Massive oral, nasal, or pharyngeal hemorrhage
Mass effect (cancer, tumor)
Structural deformities of the oropharynx
Upper airway stenosis
Cervical spine instability
Fractured larynx or significant damage to the cricoid cartilage (absolute contraindication)
Endotracheal intubation can be accomplished easily and quickly
Infants and children younger than 5 years old (relative contraindication)
Bleeding diathesis (relative contraindication)
Massive neck edema (relative contraindication)
Pearl: Make sure that the incision is large enough to allow passage of the dilator and the cricothyrotomy tube.
Pearl: Make sure to have control of the guidewire at all times to prevent its inadvertent loss into the trachea.
Incorrect/unsuccessful tube placement
Vocal cord injury
Subglottic or glottic stenosis