title: Three-step emergency cricothyroidotomy.
abstract: OBJECTIVE
  Surgical cricothyroidotomy is the airway of choice in combat. It is too dangerous for combat medics to perform orotracheal intubation, because of the time needed to complete the procedure and the light signature from the intubation equipment, which provides an easy target for the enemy. The purpose of this article was to provide a modified approach for obtaining a surgical airway in complete darkness, with night-vision goggles.
  
  
  METHODS
  At our desert surgical skills training location at Nellis Air Force Base (Las Vegas, Nevada), Air Force para-rescue personnel received training in this technique using human cadavers. This training was provided during the fall and winter months of 2003-2006.
  
  
  RESULTS
  Through trial and error, we developed a "quick and easy" method of obtaining a surgical airway in complete darkness, using three steps. The steps involve the traditional skin and cricothyroid membrane incisions but add the use of an elastic bougie as a guide for endotracheal tube placement. We have discovered that the bougie not only provides an excellent guide for tube placement but also eliminates the use of additional equipment, such as tracheal hooks or dilators. Furthermore, the bevel of the endotracheal tube displaces the cricothyroid membrane laterally, which allows placement of larger tubes and yields a better tracheal seal.
  
  
  CONCLUSIONS
  Combat medics can perform the three-step surgical cricothyroidotomy quickly and efficiently in complete darkness. An elastic bougie is required to place a larger endotracheal tube. No additional surgical equipment is needed.
authors.affiliation: Department of Surgery, University of Nevada School of Medicine, Las Vegas, NV 89102, USA.
authors.forename: Allan
authors.initials: A
authors.lastname: MacIntyre
authors.forename: Mark K
authors.initials: MK
authors.lastname: Markarian
authors.forename: Dale
authors.initials: D
authors.lastname: Carrison
authors.forename: Jay
authors.initials: J
authors.lastname: Coates
authors.forename: Deborah
authors.initials: D
authors.lastname: Kuhls
authors.forename: John J
authors.initials: JJ
authors.lastname: Fildes
mesh_terms: D002102:Cadaver; D003413:Cricoid Cartilage / Q000601:surgery*; D004632:Emergency Medical Services; D005240:Feasibility Studies; D006801:Humans; D008887:Military Medicine; D013965:Thyroidectomy / Q000379:methods*; D014481:United States; D014857:Warfare