percutaneous cricothyroidotomy
The patient should be supine. If there is no risk of cervical spine injury, extend the head to expose the neck. Prep the skin.
First identify the cricothyroid membrane. The blood vessels tend to overlie the upper third of the cricothyroid membrane. Making your puncture in the lower third will minimize the risk of hitting them.
Use the largest IV catheter possible, such as a size 10 or 14 gauge in the adult. For a child choose a smaller catheter such as an 18 or 16 gauge.
Attach a 10 ml syringe to the hub of the needle. The syringe should contain 3-5 ml of saline. Stand at the head of the bed and aim the needle slightly caudad at an angle of about 30-40 degrees. Aspirate as you advance. Your insertion should be slow and deliberate to avoid puncture of the posterior tracheal wall. As soon as you enter the tracheal lumen you will see bubbles in the saline as you aspirate air, verifying intratracheal placement.
Once you have entered the trachea, slide the catheter off the needle into the trachea. The catheter should slide easily. Immediately attach your syringe to the hub of the catheter again and aspirate air. There should be no resistance. Do not skip verification of correct placement inside the tracheal lumen because you must be absolutely sure that the catheter is correctly placed inside the trachea.<unk>  ventilation against or into the tracheal wall can cause massive subcutaneous emphysema that can cause catastrophic airway distortion and obstruction.
Steady the catheter by the hub to ensure that it doesn’t move. Keep your fingers in contact with the neck while holding the hub to avoid accidentally pulling the catheter out of position.
The patient should be supine. If there is no risk of cervical spine injury, extend the head to expose the neck. Prep the skin.
First identify the cricothyroid membrane. The blood vessels tend to overlie the upper third of the cricothyroid membrane. Making your puncture in the lower third will minimize the risk of hitting them.
Use the largest IV catheter possible, such as a size 10 or 14 gauge in the adult. For a child choose a smaller catheter such as an 18 or 16 gauge.
Attach a 10 ml syringe to the hub of the needle. The syringe should contain 3-5 ml of saline. Stand at the head of the bed and aim the needle slightly caudad at an angle of about 30-40 degrees. Aspirate as you advance. Your insertion should be slow and deliberate to avoid puncture of the posterior tracheal wall. As soon as you enter the tracheal lumen you will see bubbles in the saline as you aspirate air, verifying intratracheal placement.
Once you have entered the trachea, slide the catheter off the needle into the trachea. The catheter should slide easily. Immediately attach your syringe to the hub of the catheter again and aspirate air. There should be no resistance. Do not skip verification of correct placement inside the tracheal lumen because you must be absolutely sure that the catheter is correctly placed inside the trachea.<unk>  ventilation against or into the tracheal wall can cause massive subcutaneous emphysema that can cause catastrophic airway distortion and obstruction.
Steady the catheter by the hub to ensure that it doesn’t move. Keep your fingers in contact with the neck while holding the hub to avoid accidentally pulling the catheter out of position.
using a<unk>  ventilator
You should familiarize yourself with the<unk>  ventilator available in your institution.
0 to <5 years old- < 20 mmHg (you can also consider use of Bag-Valve device to limit peak pressure: see below)
5 to 12 years old- < 30mm/Hg
12 years old – 50 mm/Hg
Use I:E ratio of 1:4 to 1:5, with a breath rate of 10 to 12/minute for most children.
You risk tension pneumothorax if the patient cannot exhale or isn’t given enough time to exhale. Never press the trigger unless you are watching the patient’s chest.
You should familiarize yourself with the<unk>  ventilator available in your institution.
0 to <5 years old- < 20 mmHg (you can also consider use of Bag-Valve device to limit peak pressure: see below)
5 to 12 years old- < 30mm/Hg
12 years old – 50 mm/Hg
Use I:E ratio of 1:4 to 1:5, with a breath rate of 10 to 12/minute for most children.
You risk tension pneumothorax if the patient cannot exhale or isn’t given enough time to exhale. Never press the trigger unless you are watching the patient’s chest.
when a<unk>  ventilator is not available
Note: Hypercarbia Will Develop Without A<unk>  Ventilator
Although hypoxia is avoided with any of these non-jet ventilator techniques, hypercarbia will develop. This can cause significant respiratory acidosis if use of these techniques is prolonged. However, any oxygen supplied during emergency treatment of airway obstruction is useful.
Pediatric jet ventilation
Bag valve mask ventilation
Extracorporeal membrane oxygenation
Mechanical ventilation 
Neonatal resuscitation
High frequency oscillation ventilation
Oxygen therapy
Noninvasive ventilation