Emergency percutaneous dilatational cricothyroidostomy: use of modified nasal speculum.

The authors devised a percutaneous dilatational method which they believe trained physicians and nonphysicians (emergency medical technicians and paramedics) can use with safety and speed. With one blade of a modified nasal speculum embedded in a tapered small pigtail-dilator catheter, the closed, flattened instrument is forced through the cricothyroid ligament, with a twisting motion, and then opened. Only the skin is incised 1 cm in length. Then a free flow of air via attached syringe is sought before any further penetration. This guarantees accurate and safe entry into the airway. The operator forces the J-tipped dilator and speculum inward as the needle is withdrawn. At the proper depth the speculum is opened transversely, and a cuffed tracheostomy tube with an internal diameter of 6 mm is inserted. The instrument is removed and immediate suctioning and active ventilation is possible. The authors developed the use of this instrument in trials on a mannequin and on 25 cadavers.