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.
Keywords
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Article Info
Publication History
Published online: December 11, 2019
Accepted:
December 9,
2019
Received in revised form:
November 9,
2019
Received:
September 15,
2019
Footnotes
☆Meetings: None.
☆☆IRB: Approved.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
