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Ultrasound for airway management: An evidence-based review for the emergency clinician.
Am J Emerg Med. 2020 05; 38(5):1007-1013.AJ

Abstract

BACKGROUND

Airway management is a common procedure performed in the Emergency Department with significant potential for complications. Many of the traditional physical examination maneuvers have limitations in the assessment and management of difficult airways. Point-of-care ultrasound (POCUS) has been increasingly studied for the evaluation and management of the airway in a variety of settings.

OBJECTIVE

This article summarizes the current literature on POCUS for airway assessment, intubation confirmation, endotracheal tube (ETT) depth assessment, and performing cricothyroidotomy with an emphasis on those components most relevant for the Emergency Medicine clinician.

DISCUSSION

POCUS can be a useful tool for identifying difficult airways by measuring the distance from the skin to the thyrohyoid membrane, hyoid bone, or epiglottis. It can also predict ETT size better than age-based formulae. POCUS is highly accurate for confirming ETT placement in adult and pediatric patients. The typical approach involves transtracheal visualization but can also include lung sliding and diaphragmatic elevation. ETT depth can be assessed by visualizing the ETT cuff in the trachea, as well as using lung sliding and the lung pulse sign. Finally, POCUS can identify the cricothyroid membrane more quickly and accurately than the landmark-based approach.

CONCLUSION

Airway management is a core skill in the Emergency Department. POCUS can be a valuable tool with applications ranging from airway assessment to dynamic cricothyroidotomy. This paper summarizes the key literature on POCUS for airway management.

Authors+Show Affiliations

Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America. Electronic address: MichaelGottliebMD@gmail.com.Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.Department of Emergency Medicine, Advocate Christ Medical Center, Chicago, IL, United States of America.Department of Emergency Medicine, George Washington University, Washington, DC, United States of America.Department of Emergency Medicine, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, United States of America.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31843325

Citation

Gottlieb, Michael, et al. "Ultrasound for Airway Management: an Evidence-based Review for the Emergency Clinician." The American Journal of Emergency Medicine, vol. 38, no. 5, 2020, pp. 1007-1013.
Gottlieb M, Holladay D, Burns KM, et al. Ultrasound for airway management: An evidence-based review for the emergency clinician. Am J Emerg Med. 2020;38(5):1007-1013.
Gottlieb, M., Holladay, D., Burns, K. M., Nakitende, D., & Bailitz, J. (2020). Ultrasound for airway management: An evidence-based review for the emergency clinician. The American Journal of Emergency Medicine, 38(5), 1007-1013. https://doi.org/10.1016/j.ajem.2019.12.019
Gottlieb M, et al. Ultrasound for Airway Management: an Evidence-based Review for the Emergency Clinician. Am J Emerg Med. 2020;38(5):1007-1013. PubMed PMID: 31843325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound for airway management: An evidence-based review for the emergency clinician. AU - Gottlieb,Michael, AU - Holladay,Dallas, AU - Burns,Katharine M, AU - Nakitende,Damali, AU - Bailitz,John, Y1 - 2019/12/11/ PY - 2019/09/15/received PY - 2019/11/09/revised PY - 2019/12/09/accepted PY - 2019/12/18/pubmed PY - 2020/8/12/medline PY - 2019/12/18/entrez KW - Airway, intubation KW - Cricothyroidotomy KW - Endotracheal KW - Ultrasound SP - 1007 EP - 1013 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 38 IS - 5 N2 - BACKGROUND: Airway management is a common procedure performed in the Emergency Department with significant potential for complications. Many of the traditional physical examination maneuvers have limitations in the assessment and management of difficult airways. Point-of-care ultrasound (POCUS) has been increasingly studied for the evaluation and management of the airway in a variety of settings. OBJECTIVE: This article summarizes the current literature on POCUS for airway assessment, intubation confirmation, endotracheal tube (ETT) depth assessment, and performing cricothyroidotomy with an emphasis on those components most relevant for the Emergency Medicine clinician. DISCUSSION: POCUS can be a useful tool for identifying difficult airways by measuring the distance from the skin to the thyrohyoid membrane, hyoid bone, or epiglottis. It can also predict ETT size better than age-based formulae. POCUS is highly accurate for confirming ETT placement in adult and pediatric patients. The typical approach involves transtracheal visualization but can also include lung sliding and diaphragmatic elevation. ETT depth can be assessed by visualizing the ETT cuff in the trachea, as well as using lung sliding and the lung pulse sign. Finally, POCUS can identify the cricothyroid membrane more quickly and accurately than the landmark-based approach. CONCLUSION: Airway management is a core skill in the Emergency Department. POCUS can be a valuable tool with applications ranging from airway assessment to dynamic cricothyroidotomy. This paper summarizes the key literature on POCUS for airway management. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/31843325/Ultrasound_for_airway_management:_An_evidence_based_review_for_the_emergency_clinician_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(19)30816-2 DB - PRIME DP - Unbound Medicine ER -