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
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/286588/probe_position_CTM.jpg)
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/286592/Labeled_cricothyroid_US.jpg)
AIRWAYSURGICAL PREP
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/286617/probe_position_CTM_indicator.jpg)
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
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/254094/Screen_Shot_2014-01-20_at_1.55.46_PM.png)
AIRWAYSURGICAL PREP
AIRWAYintubation
airwaYintubation
AIRWAYintubation
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/286714/transverse_tracheal_probe.jpg)
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
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/254125/lungpoint_annoted.png)
AIRWAYTube placement
AIRWAYsummary
<before> surgical preparation
<during> endotracheal intubation
<after> post-tube placement
AIRWAY
paracentesis
thoracentesis
SUBCLAVIAN CENTRAL LINE
paraCENTESISprep
paracentesisprep
Paracentesistechnique
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/284247/paracentesis_position.jpg)
PARACENTESISPREP
PARACENTESISTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/284212/Paracentesis_Pocket_Depth.jpg)
PARACENTESISTECHNIQUE
PARACENTESISTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/284363/Screen_Shot_2014-03-08_at_3.30.15_PM.png)
PARACENTESISpitfalls
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/284196/IOW_Sagittal_Bladder_2.jpg)
PARACENTESISpitfalls
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/284220/sbo.gif)
PARACENTESISPITFALLS
PARACENTESIStroubleshooting
AIRWAY
paracentesis
thoracentesis
SUBCLAVIAN CENTRAL LINE
THORACENTESISprep
THORACENTESISTECHNIQUE
THORACENTESISTECHNIQUE
THORACENTESIStechnique
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/285359/thora_position_options.png)
THORACENTESISTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/285400/Screen_Shot_2014-03-09_at_7.52.19_PM.png)
THORACENTESISTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/285361/thoracentesis.jpg)
THORACENTESISTECHNIQUE
Ma OJ, Mateer JR, Blaivas M. Emergency Ultrasound 2nd ed. 2008.
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/285410/THoracentesis_marked_skin.jpg)
THORACENTESISTECHNIQUE
THORACENTESISTECHNIQUE
Adjusted hospital los by adverse events
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/285536/Screen_Shot_2014-03-09_at_11.45.12_PM.png)
Adjusted hospital cost by adverse event
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/285539/Screen_Shot_2014-03-09_at_11.45.40_PM.png)
THORACENTESISpitfalls
AIRWAY
paracentesis
thoracentesis
SUBCLAVIAN CENTRAL LINE
Subclavian Linesanatomy
rob swatski
SUBCLAVIAN LINESanatomy
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280431/subclavian.jpg)
Subclavian linesprep
[probe] linear
[preset] vascular
[parts] clavicle, 1st rib
[position] infraclavicular, supraclavicular
[picture] SC artery, SC vein, pleura, IJ, ---| |---
SUBCLAVIAN LINESTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280477/venous_spectral_dopper.jpg)
SUBCLAVIAN LINESTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280485/spectral_doppler_artery.jpg)
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280500/BLUE_BWH_T.jpg)
SUBCLAVIAN LINESTECHNIQUE
INFRACLAVICULARapproach
infraclaviculartechnique
infraclavicularTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280395/central_venous_access_subclavian_ultrasound.jpg)
INFRACLAVICULARTECHNIQUE
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280463/Screen_Shot_2014-03-06_at_12.34.01_AM.png)
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280458/labeled_transverse_subclavian_clavicle.png)
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280470/spectral_doppler_artery.jpg)
INFRACLAVICULARTECHNIQUE
infraclavicularTECHNIQUE
SUBCLAVIAN LINESANATOMY
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280431/subclavian.jpg)
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.
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/283830/Screen_Shot_2014-03-07_at_4.14.48_PM.png)
subclavian linesstats
Success rates US vs Landmark
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/283851/Screen_Shot_2014-03-07_at_4.46.30_PM.png)
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
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280431/subclavian.jpg)
SupraCLAVICULARtechnique
SupraclavicularTECHNIQUE
SUBCLAVIAN LINESpitfalls
SUBCLAVIAN LINESpractice
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/286708/blownPupil.jpg)
Limitations
airway
paracentesis
thoracentesis
subclavian lines
Thanks
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280502/BLUE_BWH_T.jpg)
Questions??
![](https://s3.amazonaws.com/media-p.slid.es/uploads/wilmachan/images/280508/US_procedures.png)
<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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