In an emergency, it does not matter what airway device is inserted. A smaller tracheostomy tube is likely to be easier to insert than a tube of the same size or larger. A size 6.0mm tracheal tube is adequate in an emergency and should be available as part of the emergency bedside equipment for cricothyroidotomy.

In Fig 1, a small endotracheal tube is used effectively.

Question: If you fail to insert a tube into the stoma, are there any other options available to you at this point?

Answer

In an emergency, it does not matter what airway device is inserted. A smaller tracheostomy tube is likely to be easier to insert than a tube of the same size or larger. A size 6.0mm tracheal tube is adequate in an emergency and should be available as part of the emergency bedside equipment for cricothyroidotomy.

In Fig 1, a small endotracheal tube is used effectively.

Question: If you fail to insert a tube into the stoma, are there any other options available to you at this point?

Answer: Emergency surgical access to the trachea is the only option available at this point. The choice depends on your skills and experience and what equipment is available:

• Cricothyroidotomy (Fig 2)
  • Surgical
  • Percutaneous
• Re-do tracheostomy
  • Surgical
  • Percutaneous (Fig 3)
• Blind or digital manipulation attempt at intubation of the stoma
• The arrival of a more experienced or skilled ‘expert’ is permitted one further best attempt at trans-laryngeal (usually oral) intubation in the latest Difficult Airway Society guidelines. This may be appropriate if new expertise or equipment arrives.

In an emergency, it does not matter what airway device is inserted. A smaller tracheostomy tube is likely to be easier to insert than a tube of the same size or larger. A size 6.0mm tracheal tube is adequate in an emergency and should be available as part of the emergency bedside equipment for cricothyroidotomy.

In Fig 1, a small endotracheal tube is used effectively.

Question: If you fail to insert a tube into the stoma, are there any other options available to you at this point?

Answer: Emergency surgical access to the trachea is the only option available at this point. The choice depends on your skills and experience and what equipment is available:

• Cricothyroidotomy (Fig 2)
  • Surgical
  • Percutaneous
• Re-do tracheostomy
  • Surgical
  • Percutaneous (Fig 3)
• Blind or digital manipulation attempt at intubation of the stoma
• The arrival of a more experienced or skilled ‘expert’ is permitted one further best attempt at trans-laryngeal (usually oral) intubation in the latest Difficult Airway Society guidelines. This may be appropriate if new expertise or equipment arrives.