Conduction of conicotomy: technique of performance, indications and contraindications
Possession of the technique of performing a conicotomy can be a saving chance in asphyxia in a patient. Of course, it's not simple, and hoping that a person without medical education can master it, it would be strange. But still this information can be useful.
What is it about
The term "conicotomy" refers to emergency medicine. This is the name for 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 a membrane. It consists of elastic fibers, the swelling of which leads to asphyxia.
Sometimes the term "conicotomy" is replaced by synonyms - "koniotomy" or "cryotyreotomy".However, the technique of performing a conicotomy does not change from this.
We indicate the main cases in which conicotomy is performed. Indications for surgery - acute cases of asphyxia. The causes of asphyxia can be as follows:
- puffiness of larynx tissues against the background of infectious processes;
- rapid allergic reaction;
- sharp spasm from exposure to chemicals or physical disturbance;
- hit by an unauthorized body;
- complication of intubation;
- injuries incompatible with laryngoscopy;
- neoplasm in the upper respiratory tract.
Contraindications to conicotomy
Since conicotomy is an emergency operation, there are almost no contraindications to its administration. It is spent both to adults, and the children who have reached 8th years. If the need for manipulation occurs earlier than this age, then the technique of conicotomy will vary significantly. Experienced doctors know this and take it into account.
Tools and materials that use for conical anatomy
A kit for emergency conicotomy should be in any medical facility and in ambulance teams.
Usually it includes:
- surgical scalpel;
- permissible form of retractor;
- tubes for tracheotomy;
- special wide needle or vascular catheter( for puncture menbranes);
- long tweezers;
- syringe for anesthesia;
- dressing and fixing material( bandage, cotton wool sticking plaster).
Many well-known firms produce special sets for conicotomy. For example, the Portex set includes a special shortened scalpel, an elastic conductor with a tracheal cannula, a connector and a catheter. And Cook Crit. Care in its kit includes:
- syringe volume 5 ml;
- puncture needle for trachea;
- scalpel and MELKER device( sharpened dilator with cannula).
In an emergency, a doctor can hold a conicotomy with a sharp knife, instead of a scalpel, and replace the tracheotomy tube with a household rubber or plastic one. 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 injured person lies on his back, a roller is placed under the shoulder blades, his head is thrown back. The doctor treats the neck skin 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 manipulation.
- The second hand takes a scalpel and performs a cross-section. The length of the incision is about 2 cm, it should cut the skin and ligament in the above place.
- The resulting hole is stretched by the expander( for trachea or Tissot).Then 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 the incision, which produces a weak effect on the adult, a special needle or vascular catheter is inserted into the trachea. From the vascular catheter must be removed after the introduction of the needle, it blocks the intake of air.
Features of children's conicotomy
Children younger than eight years of conicotomy are not recommended because of the high likelihood of damaging the thyroid, carotid artery or jugular vein. For a child'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 of
Although conicotomy is the most accessible and safe 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 frequent are:
- bleeding due to vascular injury;
- cartilage injury;
- injured thyroid;
- trauma to esophageal tissues;
- incorrect tube installation( outside the lumen or in the submucosal layer of the trachea);
- injury of the vocal cords.
If the technique of performing a conicotomy is broken or the manipulation is not performed in time, the patient may die.