LIFE-THREATENING PROBLEMS - Medicine for Mountaineering and Other Wilderness Activities - page 22

gertipsabovethesternalnotch.Apotentialerrorischoosingthespacebetweenthehyoid
bone and thyroid cartilage, which is much higher in the neck.
4. A vertical incision approximately 1.5 inches long should be made over the cricothyroid
space. Minor bleeding from the skin and underlying fat is often encountered and should
beignored.Ahorizontalincisionapproximately0.5inchinsternocleidomastoidmuscles
carotid arteries thyroid gland thyroid cartilage length should be made through the crico-
thyroid membrane.
Figure 3-6. Location of crycothyroid membrane
5. Ideally, a cuffed endotracheal tube should be inserted through the opening, but a variety
of commercial tubes can be used for the cricothyrotomy. If none are available, any firm
tubethesizeoftheinjuredperson'slittlefinger,suchasthecasingofapen,canbeinser-
ted through the opening. The tube should only be advanced 3 inches so that it does not
block one of the bronchi (usually the right). With each breath, the tube should become
fogged.Lookingformovementandlisteningforbreathsoundsonbothsidesofthechest
can ensure the tube is in a good position.
6. The tube should be taped securely to the neck to prevent dislodging it or forcing it too
deeply into the trachea.
7. If available, supplemental oxygen should be administered through the tubing.
Breathing and Circulation
If the person is not breathing and the airway is open, two rescue breaths, each lasting
more than one second, should be given. The chest should rise with each breath. After the
rescue breaths, the circulation should be assessed by checking the carotid pulse for five to
ten seconds. (In hypothermic individuals, assessing the pulse usually takes much longer.)
If no pulse is present, CPR with rescue breathing and high-quality compressions should be
considered.
Ideally, all teenagers and adults venturing into the wilderness should be prepared to
provide cardiopulmonary resuscitation (CPR). Such preparation must be obtained through
certified courses providedbyorganizations suchastheAmerican Red Cross,theAmerican
HeartAssociation,andawidevarietyofmedicalfacilities.Areviewcourseshouldbetaken
at least every two years. Such courses employ manikins for training, a facility that cannot