Another key feature of RSI is the application of manual'cricoid pressure'to the cricoid cartilage, often referred to as the " Sellick maneuver ", prior to instrumentation of the airway and intubation of the trachea.
42.
Cricoid pressure should not be confused with the " BURP " ( Backwards Upwards Rightwards Pressure ) manoeuvre, which is used to improve the view of the glottis during laryngoscopy and tracheal intubation, rather than to prevent regurgitation.
43.
Uncuffed tubes are also available, though their use is limited mostly to pediatric patients ( in small children, the cricoid cartilage, the narrowest portion of the pediatric airway, often provides an adequate seal for mechanical ventilation ).
44.
It is also anatomically related to the thyroid gland; although the thyroid isthmus is inferior to it, the two lobes of the thyroid extend superiorly on each side of the cricoid as far as the thyroid cartilage above it.
45.
The outer layer is continuous with the pretracheal fascia, attaching the gland to the cricoid and thyroid cartilages, via a thickening of the fascia to form the posterior suspensory ligament of thyroid gland also known as Berry's ligament.
46.
The first tracheal ring is broader than the rest, and often divided at one end; it is connected by the cricotracheal ligament with the lower border of the cricoid cartilage, and is sometimes blended with the next cartilage down.
47.
Hyoid bone _ God, I can't even feel the thyroid cartilage, it's gone . . . OK, the thyroid gland is about there, cricoid rings are here . . . we'll go in right here . ..
48.
The initial proposal of cricoid pressure as a useful clinical procedure, its subsequent adoption as the lynchpin of patient safety, and its current decline into disfavor represents a classic example of the need for evidence-based medicine, and the evolution of medical practice.
49.
The superior thyroid vein crosses the artery near its termination, and the middle thyroid vein a little below the level of the cricoid cartilage; the anterior jugular vein crosses the artery just above the clavicle, but is separated from it by the sternohyoid and sternothyroid.
50.
The " inferior horn " is short and thick; it is directed downward, with a slight inclination forward and medialward, and presents, on the medial side of its tip, a small oval articular facet for articulation with the side of the cricoid cartilage.
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