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FONA QUICK GUIDE

 

Emergency Front of the Neck Airway (FONA)

Scalpel-Bougie-Tube Technique

In the CICV emergency, start by
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  1. Calling for help
  2. Declaring CICV emergency to the room
  3. Ensuring paralysis
  4. Continuing oxygenation attempts via facemask, high flow O2 or LMA

Gather Equipment
Now available in a simple "FONA" kit

  • Skin prep

  • 10-0 broad blade scalpel

  • Bougie

  • 6-0 ETT

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Position Patient

Extend Head & Neck - remove pillows and place shoulder roll

Locate Landmarks

  1. Palpate neck, starting at sternal notch and working cephalad 

  2. Locate cricothyroid membrane (CTM) - located between cricoid and thyroid cartilage

  3. Stretch skin and stabilize trachea between thumb and middle finger

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STAB INCISION TO CTM

1. Stabilize trachea with nondominant hand​

2. With dominant hand, make a horizontal stab incision into CTM

TWIST

  1. Keep scalpel perpendicular to patient's neck

  2. TWIST scalpel and pull towards you to create traction within the incision

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BOUGIE

  1. Hold bougie near angled coude tip and insert perpendicular and into the trachea

  2. Push bougie along broadside of blade while inserting and angling bougie towards feet 

  3. Insert bougie to a depth of 10 cm and move to next step

TUBE

  1. Stretch skin and stabilize the trachea

  2. Railroad ETT over bougie

  3. Inflate cuff

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CHECK

  1. Confirm ETCO2 (ideally by waveform capnography)

  2. Check ETT depth

  3. Secure ETT

For Nonpalpable Structures (obesity, neck pathology, etc)

  1. CUT - Use scalpel to create an 8-10 cm vertical incision through overlying tissue

  2. FINGER DISSECTION - Pull strap muscle apart, identify CTM and stabilize trachea with hand

  3. Proceed with steps as outlines above (STAB, TWIST, BOUGIE, TUBE, CHECK)

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 **Photos courtesy of the Difficult Airway Society

Learn more

Take a look at some other fantastic resources.

01

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults 

Take me there!

03

2022 ASA Difficult Airway Guidelines - Many updates, including a streamlined Emergency Pathway. (Percutaneous or surgical techniques are recommended based on provider experience/preference. Retrograde wire intubations are no longer recommended in emergency airway mgmt)

Take me there!

05

Take a look at our Advanced Airway Management's in depth FONA how-to video and guide.

Take me there!

02

The Great Debate: Is the Scalpel Mightier than the Cannula?

Take me there!

04

The ASPF (Anesthesia Patient Safety Foundation) provides an in-depth discussion of the new 2022 ASA Difficult Airway Algorithm.

Take me there!
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