Week 8: with Jacob Avila

Finally! Jacob Avila (@5minsono) of 5minsono.com joins us the ever-interesting topic of using ultrasound in airway management – specifically in tube confirmation.  We cover the details of the exam, examples of successful and unsuccessful intubations and Jacob shares with us a world wide debut (maybe) of bougie confirmation using ultrasound.  Check out the video below!


Pearls from this week’s video:

1.  The linear probe and curvilinear probe are both acceptable probes when imaging the neck.  Jacob prefers the curvilinear probe to get a broader view of the field.
2.  Always optimize your depth and focus of the ultrasound.
3.  The esophagus is typically found lateral to the trachea, you may have to scan left and right to identify it.  Sometimes gradual pressure on the trachea can pop a posterior esophagus out.
4.  The tube is confirmed by seeing ‘movement’ in the trachea and additional air-artifacts.
5.  If the movement and artifact is outside of the trachea, it is likely an esophageal intubation.
6.  Turns out you CAN see a bougie in the trachea on ultrasound.

LASTLY, please continue the gold standard of tube confirmation with waveform capnography, color capnometry, tube visualization, chest auscultation etc.  Ultrasound is an additional method of tube confirmation and should not replace current methods.