Front of Neck Airway or Fona
As always, please feel free to pause the video and take notes as needed.
Welcome to this demonstration video on Front of Neck Airway or Fona.
The purpose of this video is to provide a visual guide for the proper securing of Front of Neck Airway or plan D of Das 2015 Guidelines.
Introduction:
A cannot Intubate Cannot Oxygenate or CICO situation arises when attempts to manage the airway by tracheal intubation, face-mask ventilation, and Supra Glottic Airway Devices insertion have failed.
Hypoxic brain damage and death will occur if the situation is not rapidly resolved.
A cannot Intubate Cannot Oxygenate and progression to front-of-neck access should be declared.
Scalpel cricothyroidotomy is the fastest and most reliable method of securing the airway in an emergency setting according to the National Audit Project 4 or Nap 4 audit.
Anesthetists must learn the scalpel technique and have regular training to avoid skill fade.
Equipment needed
Scalpel with number 10 blade; a broad blade which is the same width as the tracheal tube is essential.
Gum Elastic Bougie with angled tip.
Cuffed Endotracheal tube, size 6.0 mm.
Placeholder if available.
Lubricating Gel.
Scalpel cricothyroidotomy technique.
Neck extension is required so, in an emergency, this may be achieved by pushing a pillow under the shoulders or dropping the head of the operating table, or by pulling the patient up so that the head hangs over the top of the trolley.
Stand on the patient’s left-hand side if you are right-handed or reverse if left-handed.
The laryngeal handshake is performed with the non-dominant hand,
Identifying the hyoid and thyroid laminae, stabilizing the larynx between thumb and middle finger, and moving down the neck to palpate the cricothyroid membrane with the index finger.
Incision through the skin and cricothyroid membrane.
Hold the scalpel in your right hand, make a transverse stab incision through the skin and cricothyroid membrane with the cutting edge of the blade facing towards you.
Keep the scalpel perpendicular to the skin and turn it through 90° so that the sharp edge points caudally or towards the feet.
Swap hands; hold the scalpel with your left hand.
Maintain gentle traction, pulling the scalpel towards you or laterally with the left hand, keeping the scalpel handle vertical to the skin or not slanted.
Pick the bougie up with your right hand.
Holding the bougie parallel to the floor, at a right angle to the trachea, slide the angled tip of the bougie down the side of the scalpel blade furthest from you into the trachea.
Rotate and align the bougie with the patient’s trachea and advance gently up to 10–15 cm.
Remove the scalpel.
Stabilize trachea and tension skin with left hand.
Railroad a lubricated size 6.0 mm cuffed endotracheal tube over the bougie as it is advanced.
Avoid excessive advancement and endobronchial intubation.
Remove the Gum Elastic Bougie.
Inflate the cuff and confirm ventilation with capnography.
Many include a placeholder to keep the incision open until the tube is in place.
In some descriptions, the skin and cricothyroid membrane are cut sequentially; in others, a single incision is recommended.
In obese patients or difficult anatomy, a vertical skin incision is recommended in this situation.
100% Oxygen should be applied to the upper airway throughout, using a Supra Glottic Airway Devices, a tightly fitting face mask, or nasal insufflation.
By the end; Thank you for watching and we hope you found this video helpful.
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