Ultrasound Case 035


A 31 year old man with a receding chin and unusual jaw anatomy requires intubation after an overdose. You know this is a potentially difficult intubation in a non-fasted patient. You decide to watch the intubation with ultrasound.

Describe and interpret these scans

Image 1: Linear transducer placed transversely across the trachea slightly toward the patient’s left.

Intubation proceeds and you watch the trachea for the flutter of the cuff and a glimpse of the tube passing by, and at the same time watch the oesophagus to ensure the endotracheal tube doesn’t suddenly appear there looking like a second trachea. Fortunately in this case tracheal intubation proceeds uneventfully.


Tracheal intubation

Ultrasound can be used to monitor the intubation process and can confirm tracheal or oesophageal intubation in real time.

If inadvertent oesophageal intubation occurs it takes several “breaths” and some time before the abnormal ETCO2 pattern is realized. In this time the oesophagus and stomach is inflated and risk of aspiration increased. Ultrasound can prevent this.

The ultrasound operator can provide simultaneous laryngeal manipulation if required.



An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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