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Airway ultrasound

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Airway ultrasound

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Airway ultrasound

  1. 1. Airway Ultrasound James Rippey 2016 Dieter Kohrs 2017
  2. 2. • success rate of real emergency airway access – 36% • inability to identify the cricothyroid membrane – main contributor • identifying the cricothyroid membrane clinically in the obese has success rates of 0-39% • After some training, sonographic identification of the CTM is close to 100%
  3. 3. • a structured training programme lasting ∼1 h, leads to a clinically useful skill level • significant retention of skills exists after 6 months • ultrasound guided marking of the cricothyroid membrane is unaffected by changing neck positions • Two techniques recommended…the transverse/TACA and the longitudinal/string of pearls technique
  4. 4. • Authors recommendations… • Identify the CTM before commencing any airway management • The mean time to mark the CTM was 24 sec with the TACA method and 37 seconds with the Longitudinal method • Identify the CTM clinically and if any doubt exists, then sonographic identification should be performed!
  5. 5. Our Structured Training Program • Airway anatomy using ultrasound • Longitudinal – String of Pearls method • Transverse – TACA method • Examples • Practical session • Ultrasound for confirmation of ETT placement
  6. 6. Cricothyroid
  7. 7. Sternothyroid
  8. 8. Sternohyoid
  9. 9. Sonographic Airway Anatomy
  10. 10. 2 cm
  11. 11. 1.4 cm
  12. 12. 0.7 cm
  13. 13. Techniques
  14. 14. STEP1:Find the trachea in transverse Look for an air filled tube
  15. 15. Step2: Rotate into longitudinal section and identify the ‘string of pearls’
  16. 16. Step 3: Slide the transducer cephalad
  17. 17. Step3: Slide the transducer cephalad and identify the cricoid cartilage
  18. 18. Step 4: Identify the Cricoid cartilage, the CTM and the thyroid cartilage
  19. 19. Longitudinal Technique Marking the Cricothyroid membrane
  20. 20. Out of Plane Technique
  21. 21. Relevant Artefacts • Reverberation artefact • Shadowing • Mirror image artefact
  22. 22. Example – String of Pearls
  23. 23. Step 1 : Find the trachea in transverse
  24. 24. Step 2+3: Rotate the probe to longitudinal and slide up
  25. 25. Step3: Identify the Cricoid
  26. 26. Step4: Identify the Cricoid, the Cricothyroid membrane and Thyroid Cartilage
  27. 27. Step 5: Mark the Cricothyroid membrane
  28. 28. Anatomy in transverse section
  29. 29. Transverse or TACA technique
  30. 30. Step 1: Identify the triangular thyroid cartilage (T = Thyroid cartilage)
  31. 31. Step2: Slide the transducer caudally until the CTM is identified ( A = Airline)
  32. 32. Step 3: Slide the transducer caudally and identify the Cricoid Cartilage = C
  33. 33. Step 4: Slide the transducer back up and re-identify the Airline = A = CTM
  34. 34. Examples – both Long and Trans
  35. 35. String of Pearls Trans Long
  36. 36. String of Pearls
  37. 37. Mark and measure depth
  38. 38. TACA method clip
  39. 39. Remember veins collapse
  40. 40. Identify the pathology
  41. 41. T= Thyroid cartilage
  42. 42. T= Thyroid cartilage
  43. 43. A= Airline of the CTM
  44. 44. C= Cricoid cartilage
  45. 45. A=Airline of the CTM
  46. 46. Longitudinal section
  47. 47. What about real time needle guidance?
  48. 48. What about real time needle guidance STEP 1 • Explore the airway in transverse • Identify key features - TACA technique STEP 2 • Find the cricoid cartilage and angle cranially
  49. 49. What about real time needle guidance STEP 1 • Explore the airway in transverse • Identify key features STEP 2 • Find the cricoid cartilage and angle cranially STEP 3 • Use an out of plane technique • Watch the tip of the needle
  50. 50. So .. In Summary
  51. 51. Our Structured Training Program • Airway anatomy using ultrasound • Longitudinal – String of Pearls method • Transverse – TACA method • Examples • Practical session • Ultrasound for confirmation of ETT placement
  52. 52. The End Questions?

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