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Coda Change

Oct 15, 2018

Intubation is one of the most important procedures that we perform. There are many immediate and bedside methods of confirming tube placement. Ben Smith and Jacob Avila present how to confirm endotracheal tube placement with airway ultrasound. There has been a bad trauma come into the Emergency Department. The patient has suffered a head injury with an obvious laceration. They are agitated and being physically aggressive to staff. To make matters worse, they are in a neck collar, and have little to no jaw to speak of. Although you will need to protect the airway of this patient it is going to be difficult. What’s more, you have no access to video laryngoscopy. How will you confirm the placement of the endotracheal tube? Physical examination to confirm endotracheal tube placement has poor evidence behind it. End tidal C02 is similarly problematic. Ben and Jacob propose adding another tool to you armamentarium. Airway ultrasound. Airway ultrasound has sound evidence supporting it. It has sensitivity and specificity in the high 90s. As such, it has been added to ACLS guidelines as the way to confirm the placement of an endotracheal tube. Join Ben and Jacob as they take you through the practical tips and tricks on how to perform this skill. As they will teach you, it is possible to use ultrasound to confirm endotracheal placement in the trachea and where it is in the trachea without having you worry about insufflating the stomach causing aspiration or vomit. You can use airway ultrasound in real time to guide the intubation, with excellent accuracy eliminating the need to bag valve mask ventilate a patient.

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