BMJ Case Reports 2016; doi:10.1136/bcr-2016-214898

Carotid sheath ‘intubation’ during an emergency surgical cricothyroidotomy

  1. Jennifer F Ha3,4
  1. 1Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  2. 2Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  3. 3Department of Otorhinolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  4. 4Department of Paediatric Otorhinolaryngology Head and Neck Surgery, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Tricia Cheah, tricia.cheah{at}
  • Accepted 11 May 2016
  • Published 25 May 2016


A previously well 62-year-old man was admitted to a regional hospital, with scalp swelling, headache, fever and rigors following a scalp injury 3 weeks prior. He developed meningism with progressive left-sided hemiparesis, and had a focal seizure on his fourth day of admission. Following a generalised seizure on day 5 of admission, he was referred to a metropolitan tertiary hospital, for neurosurgical intervention of an extradural and subdural empyema.

Prior to transfer by the Royal Flying Doctor Service, he required a definitive airway and was taken to the emergency department, for sedation and intubation. Two unsuccessful attempts at orotracheal intubation were performed by the emergency physician, followed by successful placement of a laryngeal mask airway (LMA). The decision to attempt surgical cricothyroidotomy was made as the LMA did not suffice as a definitive airway. A vertical incision in the skin of the anterior neck exposed what was believed to be the cricothyroid membrane (CTM). Three attempts at insertion of an endotracheal tube …

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