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Why the obstetric department can help you with intubation..

(screenshot from Dr Haney Mallemat’s excellent site,

What? Obstetrics department and my intubation performance? Minh have you gone completely mad?

Yes I have!

Mad for airway ultrasound! This may well be a good alternative to having separate VL and DL devices. Have a single device that is multipurpose = portable ultrasound. In this paper from Malaysia, the authors argue that in hospitals that cant afford the expensive VL toys or even capnography, then getting the obstetric department ultrasound machine down for the next emergency intubation can help confirm tracheal tube placement just as reliably as capnography gold standard!

Here is the full open access article published July 2013..awesome FOAMEd!

A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

Take home points :
– There were two false interpretations due to subcutaneous air in neck from pneumothorax. These were both incorrect diagnosis of oesophageal intubation rather than tracheal intubation. So need to still keep your thinking caps on!
– Have you ever had your waveform capnography fail to start up? I have! So this is a handy option to know about and learn in case that happens ..again!
– This is the future of airway management development. Combining devices rather than having separate ones. USS and VL becomes one device. Or USS guided airway management is backup/alternative technique to VL. Be smarter and economical! Use what you already have but use it smarter! Dont worry about the VL envy!

6 Comments Post a comment
  1. I would rather rely on them to do an USS than to cut the neck. Obscure comment? Not really. After NAP4, some of my anaes colleagues maintained that the ‘best person to perform a surgical airway is the surgeon’ (imagine this said in the same parrot-like phrase Cliff Reid used in his infamous ‘propofol assassins’ rant about ‘the best induction agent is the one with which most familiar’)

    Both dogma of course. In a CICO crisis I wouldnt want the obs reg anywhere near the airway. The person with responsibility for the airway is best placed to do a surgical airway

    Ditto an USS to confirm tube placement.

    In terms of ergonomics, probably best to have anaes assistant able to scan.

    Would it not be ace to have an anaesthetic monitor that allowed adjacent screen to slave to VL or USS probe?

    I am waiting for Apple to deliver the iGas workstation, all brushed titanium, ultrathin, rapid start up, sync with iTunes and the operators iPad. It should ‘just work’


    July 7, 2013
    • thanks Tim. I think the Malaysian authors meant steal , whoops borrow ;-), the obstetric dept USS machine for ED use rather than ask the obstetric registrar to do an airway USS…but really its not that hard to do

      July 7, 2013
      • Yeah, I was just being tangential. Not relevant, sorry

        Nowadays most of us have got access to USS without having to enter the “birthing sheds” and seek one out

        I do think the mindset though of ‘instruct surgeon to cut the neck’ rather than doing it yourself in a CICO is an interesting one.

        Makes sense if it’s an ENT surgeon (Bromiley case excepted) – makes less sense if a junior obs reg or a gastroenterologist!

        Best that anaesthetists are prepared to use the scalpel….

        July 7, 2013
      • you will recall the obstetric registrar protagonist in that dark British medical drama ‘Bodies’ or was it ‘Warm bodies’
        and his surgical airway case!

        July 7, 2013
  2. johan heunis #

    Dear Minh,

    Have you done this procedure with the V scan?

    July 7, 2013

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