Editing Tracheal intubation (section)

====Cricothyrotomy====
{{Main|Cricothyrotomy}}
[[File:Larynx external en.svg|thumb|375px|alt=In cricothyrotomy, the incision or puncture is made through the cricothyroid membrane in between the thyroid cartilage and the cricoid cartilage|In cricothyrotomy, the incision or puncture is made through the [[Cricothyroid ligament|cricothyroid membrane]] in between the [[thyroid cartilage]] and the [[cricoid cartilage]]]]
[[File:Kit de Cricothyroïdotomie.JPG|thumb|alt=Cricothyrotomy kit|[[Cricothyrotomy]] kit]]

A cricothyrotomy is an incision made through the skin and [[Cricothyroid ligament|cricothyroid membrane]] to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma.<ref name=Mohan2009/> A cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine and is associated with fewer complications.<ref name=Katos2007/>

The easiest method to perform this technique is the needle cricothyrotomy (also referred to as a [[percutaneous]] dilational cricothyrotomy), in which a large-bore (12–14 [[Needle gauge comparison chart|gauge]]) [[Peripheral venous catheter|intravenous catheter]] is used to puncture the cricothyroid membrane.<ref name=Melker2007/> Oxygen can then be administered through this catheter via [[Jet ventilation|jet insufflation]]. However, while needle cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended to be a temporizing measure until a definitive airway can be established.<ref name=ATLS2004CH2/> While needle cricothyrotomy can provide adequate oxygenation, the small diameter of the cricothyrotomy catheter is insufficient for elimination of carbon dioxide (ventilation). After one hour of [[Apnea#Apneic oxygenation|apneic oxygenation]] through a needle cricothyrotomy, one can expect a [[Arterial blood gas|PaCO<sub>2</sub>]] of greater than 250&nbsp;mm Hg and an arterial [[pH]] of less than 6.72, despite an oxygen saturation of 98% or greater.<ref name=Frumin1959/> A more definitive airway can be established by performing a surgical cricothyrotomy, in which a {{convert|5|to|6|mm|in|2|abbr=on}} endotracheal tube or tracheostomy tube can be inserted through a larger incision.<ref name=Gibbs2007/>

Several manufacturers market prepackaged cricothyrotomy kits, which enable one to use either a wire-guided percutaneous dilational (Seldinger) technique, or the classic surgical technique to insert a polyvinylchloride catheter through the cricothyroid membrane. The kits may be stocked in hospital emergency departments and operating suites, as well as ambulances and other selected [[Emergency medical services|pre-hospital]] settings.<ref name=Benkhadra2008/>