EM Vivas · Front-of-neck access / surgical airway
Laryngeal handshake and CTM landmarks — viva
Anatomy viva on CTM landmarks, laryngeal handshake, and 6.0 ETT rationale.
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Study tools
Target exams
ACEMFRCEMABEM
Prompt
Identify the cricothyroid membrane on a neck model and justify tube size for emergency surgical cricothyroidotomy.
Interpretation
Reveal interpretationShowHide
Laryngeal handshake: non-dominant hand stabilises thyroid cartilage; index finger slides to soft depression between thyroid above and cricoid (complete ring) below = cricothyroid membrane. Midline avoids anterior jugulars; high incision risks cricothyroid artery. [1][2]
Tube: size 6.0 mm cuffed ETT fits adult CTM and accepts standard bougie; larger tubes tear membrane/cricoid. Confirmation is waveform capnography, not fogging or auscultation alone.[1]
If membrane impalpable (obesity): vertical midline incision, palpate membrane through wound, then transverse membrane cut. [1]
References2ShowHide
- [1]Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth, 2015.PMID 26556848
- [2]Fennessy P, Greco E, Gelber N, et al. Emergency Front-of-Neck Airway Rescue Via the Cricothyroid Membrane: A High-Resolution Computed Tomography Study of Airway Anatomy in Adults. Anesth Analg, 2021.PMID 33989226