When the patient is in the correct position, the midline is identified first, and then the thyroid cartilage, cricoid cartilage and cricothyroid membranes.

A 'laryngeal handshake' technique is shown in Fig 1:

• A: The index finger and thumb grasp the top of the larynx (the greater cornu of the hyoid bone) and roll it from side to side. The bony and cartilaginous cage of the larynx is a cone, which connects to the trachea
• B: The fingers and thumb slide down over the thyroid laminae
• C: The middle finger and thumb rest on the cricoid cartilage, with the index finger palpating the cricothyroid membrane

Fig 2 shows this technique.

Select play to watch the video.

The equipment required should ideally be readied beforehand.

The type of incision depends on how easy it is to identify the cricothyroid membrane.

You should think about which side you would prefer to stand on. If you need to perform FONA, there will not be time to rehearse. It can feel awkward performing a procedure from a different approach than you have practised.