Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Ultrasound confirmation of endotracheal tube placement

920 views

Published on

Ultrasound confirmation of endotracheal tube placement

Published in: Health & Medicine
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Ultrasound confirmation of endotracheal tube placement

  1. 1. Ultrasound confirmation of endotracheal tube placement Dr James Wheeler BSc MBBS FACEM DDU Emergency Physician, SCGH
  2. 2. Will this replace traditional methods of ETT confirmation? • Specifically, does this replace capnography and auscultation • NO! • But no single confirmatory method is entirely reliable in emergency situations, and in certain circumstance US confirmation can be a very helpful adjunct
  3. 3. Why would you do it? • Transtracheal ultrasound is a relatively SIMPLE technique • FAST (~8 sec vs 18 sec for capnography1) • May be more reliable than capnography changes in certain patient groups? • SENSITIVE and SPECIFIC 2,3,4 • The pooled sensitivity and specificity for the detection of proper ETT placement with US were: • Sensitivity: 98% (95% C.I. 97-99%); Specificity: 98% (95% C.I. 95-99%); PPV: 99.5%, NPV: 93.8% • Does not require ventilations to assess tube placement • May prevent gastric insufflation and delay in diagnosis of misplacement
  4. 4. When would you use it? • ETCO2 unreliable or not available • Cardiac arrest / massive PE • Emergency blind intubation • Patient arrives intubated and requires rapid confirmation of ETT placement • Any patient not responding as expected after ETT placement prior to attempting re-intubation
  5. 5. How do you do it? Direct (Transtracheal) • Looking for evidence of direct endotracheal intubation or oesophageal intubation (a “second trachea”) • During intubation OR Post-intubation Indirect (Transthoracic) • Looking at the pleural space for evidence of lung ventilation (pleural movement) • Post-intubation
  6. 6. Direct: Technique Probe: • high frequency (6-12MHz) linear probe (but can use lower freq micro convex or curvilinear in obese) Preset: • Superficial, depth sufficient to see posterior to trachea, focal zone at trachea Probe placement: • in transverse plane just above the suprasternal notch • i.e. beneath cricoid
  7. 7. Direct: Technique Endotracheal intubation: • One air-mucosal interface • Hyperechoic reverberation artifacts inside trachea OR Oesophageal intubation: • Dynamic opening of the oesophagus by the ETT seen on US performed during laryngoscopy • Two air-mucosal interfaces (“two tracheas” , “double track sign”) • Hyperechoic reverberation artifacts inside oesophagus May also interrogate cuff position by infiltrating saline
  8. 8. Direct: US Anatomy
  9. 9. Direct: Tracheal Intubation
  10. 10. Direct - Oesophageal Intubation
  11. 11. Indirect • Looking at the pleural space for evidence of lung ventilation (pleural movement) • Differential pleural movement may indicate RMS intubation • Requires ventilation
  12. 12. Indirect US Anatomy
  13. 13. Indirect: Ventilating Lung
  14. 14. Indirect: Non-Ventilating Lung
  15. 15. Indirect: Pneumothorax
  16. 16. Indirect: PTX Lung Point
  17. 17. Pitfalls? • Requires access to US machine • No single confirmatory method is entirely reliable (esp. in emergency situations) • Operator dependent • Surgical emphysema can obscure view • Can’t identify supraglottic airway • Pneumothorax (for indirect)
  18. 18. References 1. Reliability of Ultrasonography in Confirming Endotracheal Tube Placement in an Emergency Setting. Vimal Koshy, Thomas et al. Indian J Crit Care Med. 2017 May; 21(5): 257–261. 2. Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis. Das SK1, Choupoo NS, Haldar R, Lahkar A. Can J Anaesth. 2015 Apr;62(4):413-23 3. Ultrasonography for confirmation of endotracheal tube placement: A systematic review and meta-analysis. Eric H.Chou et al. Resuscitation, Volume 90, May 2015, 97-103 4. Can Transtracheal Ultrasonography Be Used to Verify Endotracheal Tube Placement? Gottlieb M, Bailitz J .Ann Emerg Med. 2015 Oct; 66(4): 394-5

×