Scalpel-finger-bougie cricothyrotomy: Passing bougie into trachea with a scalpel in the opening

After the horizontal stab incision is made in the cricothyroid membrane (CTM), the clinician passes the tracheal tube introducer (ie, bougie) into the trachea. Placement is confirmed by palpating tracheal rings as the bougie is advanced and by appreciating resistance if the bougie reaches the carina or mainstem bronchus. In the photograph above, the scalpel remains in the CTM incision, stenting it open to facilitate passage of the bougie. Alternatively, the scalpel can be removed and the bougie placed after the CTM incision is dilated by the clinician's finger. Following dilation, the finger remains in place to help guide the bougie.