retrograde intubation: ol”>American Journal of Emergency Medicine 35 (2017) 171-190

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American Journal of Emergency Medicine

journal homepage: www. elsevier. com/ locate/ajem

Correspondence

Ultrasound for retrograde intubation: old wine in a new bottle?,??

To the Editor,

The article by Sanguanwit et al is indeed interesting [1]. We agree that retrograde intubation is useful for patients who are breathing and have distorted anatomy that makes orotracheal intubation difficult. Sev- eral problems were documented with retrograde intubation, regardless of the complications and contraindications described [2] earlier. The util- ity of retrograde intubation is unquestionable when fiberoptic broncho- scope is not available, and other methods are not applicable. We would like to share our recent experience on ultrasound guided retrograde intu- bation carried out in a patient who had facial and Neck trauma.

A 26-year-old male painter was brought to the emergency depart- ment with alleged history of accidental Fall from a ladder while painting and sustained facial injury. On arrival, he was drowsy and disoriented, and hemodynamically stable but his oxygen saturation was 92% with 15 L of oxygen by non-rebreathing oxygen mask. primary survey revealed an Obstructed airway due to active bleeding in the oral cavity and an Unstable cervical spine fracture for which he was immobilized with a cervical collar.

Considering the clinical and radiological status, it was decided to proceed with retrograde intubation and protect airway, as we did not have fiberoptic bronchoscope at that point of time. Under ultrasound guidance, a 16G needle was inserted into the tracheal lumen via the Cricothyroid membrane, through which an epidural catheter was intro- duced and retrieved the catheter through oral cavity. An 8-mm orotracheal tube was carefully railroaded into position. Tracheal intuba- tion was confirmed by end-tidal CO₂ monitoring.

Currently, Ultrasound imaging in airway management is gaining im-

portance due to its portability, noninvasive nature and the relatively su- perficial anatomical position of the laryngopharynx [3]. Vieira and colleagues [4] have successfully utilized the ultrasound for retrograde tracheal intubation in a patient with critical airway obstruction due to a ‘friable, haemorrhagic’ periglottic tumor. By performing ultrasound guided retrograde intubation, the complications such as injury to blood vessels, subcutaneous emphysema or caudal migration of the guide wire etc., are likely be avoided and the success rate is greater when compared with “blind” retrograde intubation.

In view of the usefulness of retrograde intubation in resource limited environ or certain clinical situations, health science trainees have to be trained to acquire the skills of this procedure using mannequin before contemplating in real life condition.

Subramanian Senthilkumaran, MD Department of Emergency and Critical Care Bewell Hospitals, Erode, Tamil Nadu, India

Corresponding author at: Department of Emergency & Critical Care Medicine, Bewell Hospitals, Erode, Tamil Nadu, India Tel.: +91 999 4634 444, +91 984 6349 444

E-mail address: [email protected]

M.P. Senthilraj, MD Department of Emergency Medicine Hamad Medical Corporation, Doha, Qatar

Narendra Nath Jena, MPH Department of Emergency Medicine, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India

Ponniah Thirumalaikolundusubramanian, MD Department of Internal Medicine, Chennai Medical College Hospital and Research Center, Irungalur, Trichy, Tamil Nadu, India

http://dx.doi.org/10.1016/j.ajem.2016.09.039

References

1. Sanguanwit P, Trainarongsakul T, Kaewsawang N, Sawanyawisuth K, Sitthichanbuncha YI. Retrograde intubation more successful than direct laryngoscopic technique in difficult endotracheal intubation? Am J Emerg Med 2016;34:2384-7.
2. Gill M, Madden MJ, Green SM. Retrograde endotracheal intubation: an investigation of indications, complications, and patient outcomes. Am J Emerg Med 2005;23:123-6.
3. Mallin M, Curtis K, Dawson M, Ockerse P, Ahern M. Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated failed intubation. Am J Emerg Med 2014;32:61-3.
4. Vieira D, Lages N, Dias J, Maria L, Correia C. Ultrasound-guided retrograde intubation. Anaesthesia 2013;68:1075-6

   Evaluation of a short intervention on screening for intimate partner violence in an ED?

   

   To the Editor,

   intimate partner violence is widespread [1,2], associated with adverse health outcomes [1,3-6], and underreported. Women who experience IPV access the emergency department (ED) more frequently than nonabused women; the majority of these visits are for chronic conditions rather than for physical injuries [7,8]. Despite recommendations for emergency medicine (EM) physicians to screen all female patients for IPV [9,10], low rates (4%-29%) of universal screening persist [11-14].

   ? Financial support - Nil.

   ?? Conflict of interest - Nil.

   ? Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

   0735-6757/(C) 2016