Lecture Notes: Airway Ultrasound by Jay Avila

Introduction

• The speaker, Jay Avila, discusses plans to share lectures online for free Open Access Medical Education (FOAMed).
• The focus of the lecture is on Airway Ultrasound, a technique not commonly used but valuable in specific applications.

Objectives

1. Understanding endotracheal vs. esophageal intubation and the role of ultrasound.
2. Differentiating tracheal vs. bronchial intubation and ensuring correct ET tube placement.

Equipment

• Probes: Use linear or curvilinear transducers.
  • The curvilinear transducer is preferred for a wider view despite lower resolution.
• Placement: Superasternal notch or lateral to it.
• Preparation: Keep a rag to remove gel for external manipulation when necessary.

Key Ultrasound Techniques

Identifying Structures

• Trachea: Anterior hyper echoic arc with acoustic shadowing.
• Esophagus: Circular structure with well-defined walls, usually to the left of the trachea.

Esophageal Intubation

• Look for double trachea sign or second air mucosal surface.
• Confirm tracheal intubation by observing tracheal movement and changes in air artifacts.

Use of Bougie

• Bougie can confirm tracheal placement before full intubation by observing tickling of superficial trachea.

Practical Considerations

• Always conduct pre-intubation survey scans to locate trachea and esophagus.
• Dynamic ultrasound during intubation requires two operators, one for intubation and one for scanning.
• Post-intubation checks can confirm tube placement via ultrasound by identifying trachea and esophagus.

Tracheal vs. Bronchial Intubation

• Verify endotracheal tube placement depth to prevent complications like pneumothorax.
• Use ultrasound to identify balloon placement at the suprasternal notch.
• Techniques:
  • Inflate cuff with air or saline for visualization.
  • Use diaphragm movement and lung sliding to confirm bilateral ventilation.

Why Use Ultrasound?

• Useful when traditional methods (e.g., VL, capnography) are inadequate.
• Beneficial in difficult intubations such as massive GI bleeds or equipment failure.

Accuracy

• Ultrasound has high sensitivity and specificity when compared to capnography.

Conclusion

• Airway ultrasound is not used routinely but is highly beneficial in specific situations.
• For more resources and courses, visit coreultrasound.com, which includes a question bank for ultrasound image identification.

Additional Resources

• Website: Coreultrasound.com for courses and question banks.
• Social Media: Check for updates and new content.