ICU · Airway management
Front-of-Neck Access — Surgical Airway, Cricothyroidotomy & Tracheostomy
Also known as Front of neck access · FONA · Surgical airway · Cricothyroidotomy · Scalpel-bougie cricothyroidotomy · Emergency tracheostomy · Needle cricothyroidotomy · Laryngeal handshake · CICO rescue · Surgical airway · Emergency surgical airway · eFONA · Cricothyrotomy · Trans-tracheal jet ventilation
Front-of-neck access (FONA) is the rescue for can't-intubate-can't-oxygenate (CICO). The emergency standard is the scalpel-bougie cricothyroidotomy: identify the cricothyroid membrane with the laryngeal handshake, a transverse stab incision, pass a bougie, railroad a cuffed size 6.0 tube, and confirm with capnography. Cricothyroidotomy is preferred over tracheostomy for the emergency because it is faster, more superficial, and bleeds less; formal tracheostomy is an elective, lower-neck procedure. The fatal error, highlighted by NAP4, is delay. Children, laryngeal trauma, and tracheal disruption are relative contraindications to cricothyroidotomy.
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