Ultrasound is routinely used in the ED setting to assist in performing procedures. With the ARHT’s recent purchase of a Sonosite Nanomaxx, we have the capability to take ultrasound guided procedures into the prehospital setting.
This paper from Academic Emergency Medicine, 2012, describes the use of ultrasound in emergency surgical cricothyroidotomy.
The technique is described and shown in a video podcast from ultrasoundpodcast.com. I highly recommend having a look round this site, there’s some great stuff there.
The video podcast is here
(Just in case anyone is wondering, I’m not advocating that we get scrubbed/gowned/masked for prehospital surgical airways!)
The cricothyroid membrane looks fairly straightforward to identify on ultrasound:
In the setting of managing a difficult airway in the prehospital setting, specifically a predicted difficult RSI with your surgical kit out and ready to go should laryngoscopy/bougie fail, there may be a role for ultrasound.
Potential uses could scanning pre-RSI to check that the trachea is in the midline (especially if a patient has difficult-to-palpate neck anatomy), identifying the cricothyroid membrane and marking the area with a pen, or using real-time ultrasound guidance to make a cut or insert a needle (either for a Seldinger technique or just to act as a guide for your scalpel). Clearly this could add a few seconds to the procedure, but in the setting of a patient with difficult anatomy (obese, subcutaneous emphysema) could mean the difference between success and failure.
i think there really could be a role. i remember reading this paper and initially thinking, time may be too much of a constraint. But in the setting where it ends up being an unanticipated difficult airway (or a semi-anticipated) difficulty airway, a quick pre-scan could end up helping you out in a big way. Then if you have to go to a cric you’ll have a solid idea of the landmarks. Not sure the role if you get a patient who needs it immediately as soon as they role in but definitely think this is something to add to the repertoire. Great post!