ultrasound
<guided>
Procedures
03.11.2014
brigham & women's hospital
emergency medicine // ultrasound // HAEMR
AIRWAY
paracentesis
thoracentesis
SUBCLAVIAN CENTRAL LINE
airway
before
during
after
Airway
<before> surgical preparation
<during> endotracheal intubation
<after> post-tube placement
AIRWAYSURGICAL PREP
AIRWAYSURGICAL PREP
AIRWAYSURGICAL PREP
AIRWAYSURGICAL PREP
airwaysurgical prep
AIRWAYSURGICAL PREP???
AIRWAYSURGICAL PREP
Aslani A et al. Accuracy of identification of the cricothyroid membrane in female subjects using palpation: An observational study. Anesth Analg 2012 May; 114:987.
AIRWAYSURGICAL PREP
AIRWAYSURGICAL PREP
AIRWAYintubation
airwaYintubation
AIRWAYintubation
airwayintubation
AIRWAYintubation
TRUE protocol (2011) during emergent intubation
---
93% concordance : wave-capnography
median time: 9sec
---
Chou recommends real-time US to
confirm airway during CPR in trained hands
AIRWAYINTUBATION
indirect confirmation
use other modalities to corroborate
AIRWAYTUBE PLACEMENT
AIRWAYTUBE PLACEMENT
[probe] linear or curvilinear
AIRWAYTUBE PLACEMENt
airwaytube placement
AIRWAYtube placement
AIRWAYTube placement
AIRWAYsummary
<before> surgical preparation
<during> endotracheal intubation
<after> post-tube placement
AIRWAY
paracentesis
thoracentesis
SUBCLAVIAN CENTRAL LINE
paraCENTESISprep
paracentesisprep
Paracentesistechnique
PARACENTESISPREP
PARACENTESISTECHNIQUE
PARACENTESISTECHNIQUE
PARACENTESISTECHNIQUE
PARACENTESISpitfalls
PARACENTESISpitfalls
PARACENTESISPITFALLS
PARACENTESIStroubleshooting
AIRWAY
paracentesis
thoracentesis
SUBCLAVIAN CENTRAL LINE
THORACENTESISprep
THORACENTESISTECHNIQUE
THORACENTESISTECHNIQUE
THORACENTESIStechnique
THORACENTESISTECHNIQUE
THORACENTESISTECHNIQUE
THORACENTESISTECHNIQUE
Ma OJ, Mateer JR, Blaivas M. Emergency Ultrasound 2nd ed. 2008.
THORACENTESISTECHNIQUE
THORACENTESISTECHNIQUE
Adjusted hospital los by adverse events
Adjusted hospital cost by adverse event
THORACENTESISpitfalls
AIRWAY
paracentesis
thoracentesis
SUBCLAVIAN CENTRAL LINE
Subclavian Linesanatomy
rob swatski
SUBCLAVIAN LINESanatomy
Subclavian linesprep
[probe] linear
[preset] vascular
[parts] clavicle, 1st rib
[position] infraclavicular, supraclavicular
[picture] SC artery, SC vein, pleura, IJ, ---| |---
SUBCLAVIAN LINESTECHNIQUE
SUBCLAVIAN LINESTECHNIQUE
SUBCLAVIAN LINESTECHNIQUE
INFRACLAVICULARapproach
infraclaviculartechnique
infraclavicularTECHNIQUE
INFRACLAVICULARTECHNIQUE
INFRACLAVICULARTECHNIQUE
infraclavicularTECHNIQUE
SUBCLAVIAN LINESANATOMY
SUBCLAVIAN LINESSTATs
Fragou M, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med. 2011 Jul;39(7):1607-12.
subclavian linesstats
Success rates US vs Landmark
SUBCLAVIAN LINESstats
Gualtieri E, Deppe SA, Sipperly ME, Thompson DR. Subclavian venous
catheterization: greater success rate for less experienced operators using
ultrasound guidance. Crit Care Med. 1995 Apr;23(4):692-7..
supraCLAVICULARapproach
SUBCLAVIAN LINESANATOMY
SupraCLAVICULARtechnique
SupraclavicularTECHNIQUE
SUBCLAVIAN LINESpitfalls
SUBCLAVIAN LINESpractice
Limitations
airway
paracentesis
thoracentesis
subclavian lines
Thanks
Questions??
<REferences>
Dawson M, Mallin M. Introduction to Bedside Ultrasound, Volumes 1 &2; Lexington, KY: Emergency Ultrasound Solutions.
Runyon BA. Paracentesis of ascitic fluid. A safe procedure. Arch Intern Med. 1986 Nov;146(11):2259-61.
Ma OJ, Mateer JR, Blaivas M. Emergency Ultrasound 2nd ed. 2008.
ultrasound assisted procedures
By wilma chan
ultrasound assisted procedures
#ultrasound, #procedures, #emergencymedicine
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