The surgical airway | Right Decisions

Right Decisions
North of Scotland major trauma guidelines
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Reception & resuscitation
The surgical airway

Update your RDS mobile app to v4.7.2 to download toolkits even when website is down.

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.

Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Equipment checklist (mandatory)

Scalpel
Tracheal hook
Bougie (155mm for adult)
Size 6.0 Tracheostomy tube (Portex; obturator removed)
Tracheostomy ties
Size 6.0 Endotracheal tube
10ml Syringe.

Clipboard

Procedures

Ensure Anaesthetics have been alerted and are attending.
Unless in emergency, prepare skin with chlorhexidine, don sterile gloves, mark cricothyroid membrane with skin marker & consider infiltration with 2% Lignocaine / Adrenaline 5ml sub-cutaneously.
Identify cricothyroid membrane; stabilize with non-dominant hand.
With scalpel in dominant hand, incise cricothyroid membrane horizontally using “stab / rocking’” technique. Hold scalpel blade in position. (Do not remove)
Insert bougie into trachea with scalpel in place. Insert size 6 tracheostomy tube (or oral endo-tracheal tube) over bougie (lubricated if necessary) into trachea, before removing scalpel.
Remove bougie whilst maintaining tracheostomy tube position.
Inflate cuff & verify ventilation and tube position as per standard anaesthesia post-intubation checks. Secure tracheostomy tube with ties.

Modifications

If the cricothyroid membrane cannot be identified easily using surface landmarks, first use a midline longitudinal incision to identify the underlying structures then proceed with the horizontal incision.
If there are significant face and neck burns or oedema (e.g., risk of further swelling), a size 6.0 ETT may be chosen instead of a tracheostomy tube.
If the surgical cricothyroidotomy fails, consider reinserting iGel / LMA for transfer/until further expert assistance arrives.