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.
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.