Post  Cricothyrotomy / Endotracheal  Intubation Checklist

• Double check placement with waveform capnography or capnometry, placed directly on ET tube adapter.
• Check proper tube depth (not main stem) by auscultating bilateral lung sounds.
• Check that tube is secured (suture to skin + tie with girth hitch around neck, should be able to fit 2 fingers under the tube tie).
• Bag‐valve‐mask (BVM) with positive end‐expiratory pressure (PEEP) valve @ 5 of PEEP at proper volume (one hand moderate squeeze) and proper rate (one squeeze every 5-6 seconds).
• Provide adequate analgesia and sedation. (Follow the JTS Analgesia and Sedation Management During Prolonged Field Care CPG.) ¹
• Calculate remaining medication and establish analgesia and sedation plan. A patient with a cricothyroidotomy may not require heavy continuous sedation.
• Raise the head and torso to 30 - 45°.
• Filter and humidify the air with a heat moisture exchanger. Place HME in-line distal to EtCO₂ device.
• As needed, place in-line suction for the tube, and suction the mouth for any excess secretions.
• Check cuff pressure (palpate bulb – should be moderately firm but still compressible).
• Place orogastric tube, if available.
• Put a BVM +PEEP valve at the bedside if using a mechanical ventilator.
• Decontaminate the mouth with chlorhexidine swab or toothbrush without paste as per the nursing care plan.

Reference

1. Joint Trauma System. Analgesia and Sedation Management During Prolonged Field Care, 11 May 2017 Clinical Practice Guideline.