Application of Ultrasound in Airway Management


longitudinal “String of Pearls” (SOP) technique

Hi everyone, I hope your week is going well. I have recently played with ultrasound more often at work and grow fond of it. The topic on airway is one of my favorites since we have to deal with this everyday. In addition, we had a lost airway case. This made me think what we can do to minimize the incident of losing airway. Often times, we are hesitant to cut the neck for two reasons: 1) we have never done it before and we are not comfortable with the scalpel; 2) when we need to cut the neck, the anatomy is not always the best. These two factors make us delay our decision making to perform scalpel cricothyrotomy.

Hence, I am here doing another post on the airway management with the use of ultrasound. The patient whose airway was lost had a deviated trachea making it impossible to gain access to trachea in a timely manner. Ultrasound in this case would be helpful in identifying the cricothyroid membrane. Additionally it could help visualize carotids to minimize accidental puncture of blood vessels. First of all you place your probe longitudinally, you will see this string of pearls. Right about the ‘string bean’, you can see the hyperechoic line. That is THE CRICOTHYROID MEMBRANE. This is where either the needle or scalpel needs to go.

transverse “Thyroid-Airline-Cricoid-Airline” (TACA) technique

Once you identify the cricothyroid membrane, you can turn your probe horizontally. This is called transverse “Thyroid-Airline-Cricoid-Airline” (TACA) technique. Here you can see the cricoid cartilage to future confirm the location if needed.

The ultrasound approach is quick and easy. During crisis situation, the other provide to consider the surgical approach while the main person is attempting to improve oxygenation. I hope this is helpful for your practice. Have a good memorial weekend.

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