This MRCS Part B station tests your knowledge of the anatomy of the thyroid gland and surrounding structures.

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How would you perform a needle cricothryroid puncture?

This is an emergency procedure. In as sterile conditions as possible, I would locate the cricothyroid membrane by running a finger down from the thyroid notch and palpating for the slight depression between it and the cricoid cartilage. I would insert a 12/14 gauge cannula connected to a syringe containing 1ml of air. Once I felt it go through the membrane, I would inject the air into the trachea to displace any skin plug, and remove the needle and secure the cannula in place. I would then connect it to an oxygen supply using a Y connector and commence jet insufflation (using oxygen tubing with a small hole in it) at a rate of 1 second on, 4 seconds off. I would ensure help was on its way so that a more definitive airway could be established.