- narrow bore tracheostomy tube inserted through the cricothyroid membrane
- Suction therapy for sputum retention
- Weaning off IPPV
- Maintain stoma patency (so that emergency reinsertion of tracheostomy is possible)
- Emergency airway and oxygen delivery
e.g. Portex Mini Trach II
- Guarded scalpel allows correct midline incision to be made with minimal risk of damage to the posterior tracheal wall
- Curved introducer aids introduction of the cannula
- 4mm ID, thermosensitive, Blue Line Cannula
- Neck tapes for secure fixation of the Cannula to the neck
- 10F Suction Catheter
- Low friction endobronchial catheter for initial suctioning following cannulation
- Inadequate spontaneous ventilation
- Age <12 years
- Platelets <100,000/mm
- Marked uraemia
- Gross obesity or obscure anatomy
- Calcified larynx
METHOD OF USE / INSERTION
- standard precautions and patient preparation
- full neck extension
- identify cricothyroid membrane
- use Seldinger technique with serial dilation as for standard percutaneous tracheostomy (Ciaglia technique), but insert through the cricothyroid membrane
- On completion of procedure, apply tracheostomy dressing and secure MiniTrach tube with tracheostomy tapes
- suction aseptically
- tracheal damage
- tracheal transection
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.