How to Perform an Emergency Tracheotomy (Cricothyroidotomy)

Performing an emergency tracheotomy is one of the strange survival methods you may need to familiarize yourself with if you spend a lot of time in the wilderness. 

DISCLAIMER: This is a dangerous, potentially fatal procedure that should only be attempted in life-threatening emergencies. Use at your own risk.

If one of your companions suffers a severe facial, nasal or neck injury while out in the wild, they may risk suffocating to death unless an emergency tracheotomy is performed. The reason for this is that the windpipe has become crushed or blocked such that air can no longer pass through. 

This procedure involves creating a hole in the windpipe in order to enable the patient to breathe. Like all strange survival methods, this procedure, which is formally known as a cricothyroidotomy, should only be performed as a last resort. Other less invasive procedures, such as CPR or the Heimlich maneuver, should be attempted first in order to restore normal breathing.

What’s the difference between a Tracheotomy and Cricothyroidotomy?

The short answer is where and when they’re performed. Each involves making an incision in the windpipe, but in different locations. 

A cricothyroidotomy is an emergency procedure done in the field (during combat, wilderness survival, etc.). The incision is made just below the Adam’s apple, in the cricothyroid membrane. 

A tracheotomy is typically performed in an emergency room or ICU under more controlled circumstances. The incision is made lower on the throat, in between the tracheal rings.

For our purposes here, we’ll focus on the cricothyroidotomy.

How to Perform an Emergency Cricothyroidotomy (aka: Emergency Tracheotomy)

Materials Needed

If you have to perform a cricothyroidotomy, you will need the following materials:

  • A very sharp knife or a razor.
  • A breathing tube. A stiff straw would be ideal, although you can use the tube from a ballpoint pen or even a rolled up playing card. You want rigid material; if it collapses, air cannot flow through. Of course, if you have a first aid kit, it may have a tracheotomy tube included that you can use.
  • Tape

Note that you may not have time to sterilize the materials beforehand since you need to open the patient’s windpipe as soon as possible. Every second without oxygen increases the chances for brain damage. If you have some high proof alcohol handy (after all, it may be the reason you’re in this predicament) then use it to sterilize the equipment. But remember that time is of the essence.

Step - By - Step Instructions

emergency tracheotomy (cricothyroidotomy)Illustration courtesy of the US Marine Corps FMST 1418

1. Start by finding the Adam’s apple, also known as the thyroid cartilage. Contrary to popular belief, women do have an Adam’s apple (an Eve’s apple?). It is just more pronounced on men. 

2. Move your finger downward until you find the cricoid cartilage, which is a small bulge about 3/4” below the Adam’s apple. The area between these two bulges is called the cricothyroid membrane, which is where the procedure will be performed.

3. Use the knife or blade to make a small horizontal incision a half-inch wide and a half-inch deep. Do NOT go deeper than this or you may cut through the windpipe. If you do it correctly, there should not be too much blood.

4. Pinch the incision open or place your finger inside to keep the hole open.

5. Place the tube into the incision to a depth of around a three-quarters inch to one inch.

6. Make two quick breaths into the tube. Pause for five seconds then breathe into the tube once every five seconds. The patient should start breathing again if you have performed the procedure correctly.

As with other strange survival methods, you should follow an emergency tracheotomy or emergency cricothyroidotomy up with basic first aid. Make sure that the tube stays in place, secure it with tape if possible, ensuring that it is not dislodged until emergency aid arrives.

More reading on Emergenecy Cricothyroidotomy and other survival medical procedures here.

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