Use standard nasal cannula for emergency cricothyrotomy

When performing a needle cricothyrotomy on a child under the age of 12, use a nasal cannula for a "poor man’s jet insufflation." "After the angiocath is inserted through the cricothyroid membrane, I recommend placing one prong of a standard nasal cannula into the hub of the angiocath," says Carolynn Zonia, DO, FACEP, education director in the ED at St. Francis Hospital in Evanston, IL. Attach the cannula tubing to oxygen flow at a rate of ~10 litres. When you occlude, or "pinch" the other prong of the cannula, you will be delivering oxygen through the angio. Watch for the chest to rise. When you release the second prong, oxygen will flow out that prong, instead of the angio, because of the size differential. This technique only allows limited (30-45 minutes) time for airway control, and is considered a bridging mechanism until the ENT can arrive and perform a tracheostomy.

Another quick tip for kids who need oxygen and are afraid of the cannula/mask/prongs: Cut a small hole in the bottom of a Styrofoam cup and put the cannula in that. "Many times, the kids will try to "drink" from the cup, getting their oxygen supplied by having their face near the cup." says Zonia.

Editor’s note: Each month, ED Nursing will share a Tip of the Month with our readers. We’d love to include your ED’s tip. Contact Staci Bonner, Editor, American Health Consultants, P.O.Box 740056, Atlanta, GA 30374. Telephone: (516) 626-0147. Fax: (516) 626-2957. E-mail: SBonner301@aol.com