Emergency pediatric tracheostomy: a usable technique and model for instruction.
Tracheostomies, although rarely performed, may be necessary in cases in which a cricothyrotomy is precluded by the small size of the cricothyroid space in infants and small children, when there is a high-grade upper airway obstruction, or when massive neck swelling or laryngeal fractures obscure the cricothyroid landmarks. A new technique for emergency pediatric tracheostomy and a model for practicing the procedure in cats has been developed. The technique uses a finder needle and a saline-filled syringe to locate the small and poorly defined trachea. Free-flowing saline or aspirated air bubbles indicate entrance of the locator needle into the tracheal lumen. A stabbing incision is made lateral to and against the needle, the stoma is spread, and an endotracheal tube is introduced. Kittens weighing 1,000 g to 1,500 g have a tracheal diameter of 5.5 mm to 6.0 mm, equivalent to a child less than 1 year old. Cats in the 2,000-g to 3,000-g range approximate the tracheal size for an older child. Either recently killed or anesthetized cats may be used. Using this model, emergency physicians can become more proficient in performing tracheostomies rapidly on small subjects. This technique, however, has not been studied in human beings of the pediatric age group.
D000818:Animals; D002415:Cats; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000033:anatomy & histology; D004630:Emergencies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008954:Models, Biological; D014140:Tracheotomy / Q000379:methods*