Ultrasound-assisted surgical airway

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:

cricothyroid

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.

Thoughts?

Lung ultrasound for pneumothorax: literature for practice and simulation

From the ‘Sim and Choppers’ blog by Dr Andrew Petrosoniak – a post with links to studies about use of ultrasound ‘M mode’ while in a helicopter, evidence suggesting that we need to scan further down the chest than many protocols suggest, and a fantastic idea for simulating lung ultrasound for training purposes.

Read the post here…      Many thanks Andrew!

Time-motion mode lung ultrasound. (a) Normal lung and (b) pneumothorax patterns using time-motion (M) mode lung ultrasound. In time motion mode, one must first locate the pleural line (white arrow) and, above it, the motionless parietal structures. Below the pleural line, lung sliding appears as a homogenous granular pattern (a). In the case of pneumothorax and absent lung sliding, horizontal lines only are visualised (b). In a patient examined in the supine position with partial pneumothorax, normal lung sliding and absence of lung sliding may coexist in lateral regions of the chest wall. In this boundary region, called the ‘lung point’ (P), lung sliding appears (granular pattern) and disappears (strictly horizontal lines) with inspiration when using the time-motion mode.

Bouhemad et al. Critical Care 2007 11:205   doi:10.1186/cc5668