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or endotracheal intubation to manage the airway. In extreme circumstances with appropri-
ate expertise available, an emergency tracheostomy or cricothyrotomy may be warranted.
Figure 3-4. Jaw thrust technique
Cricothyrotomy
A cricothyrotomy, a surgical airway similar to a tracheostomy, is rarely needed in the
wilderness but may be lifesaving for an unconscious injured person who needs to be safely
transported or for an individual with an extensive facial or jaw injury that results in un-
controllable bleeding into the mouth and throat or obstruction of the airway. However, the
neck contains major blood vessels close to the trachea. Cricothyrotomy should only be at-
tempted by an individual experienced with the procedure or, under extreme conditions, in-
structed by a physician through telecommunication. Optimally, a skin antiseptic and local
anesthesia should be available.
Figure 3-5. Oropharyngeal airway in place in an unconscious person
The steps in an emergency cricothyrotomy in the wilderness are:
1. Theinjuredpersonshouldbeinasupinepositionwitharollofclothingbehindtheneck,
unless a cervical vertebral fracture is suspected.
2. If time permits, attendants should scrub their hands and forearms and the injured indi-
vidual'sneckfromthechintotheclaviclewithsoap.Anantiseptic,suchasBetadine®or
alcohol, should be painted on the cleansed neck. Attendants should put on sterile gloves
if they are available.
3. A cricothyrotomy is so named because the opening in the trachea is made between the
cricoid cartilage and the thyroid cartilage ( Fig. 3-6 ) . This site is usually four or five fin-
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