scholarly journals Ability of Critical Care Medics to Confirm Endotracheal Tube Placement by Ultrasound

2020 ◽  
Vol 35 (6) ◽  
pp. 629-631
Author(s):  
Michael Joyce ◽  
Jordan Tozer ◽  
Michael Vitto ◽  
David Evans
Keyword(s):  
Critical Care ◽  
Endotracheal Tube ◽  
Life Support ◽  
Point Of Care ◽  
Training Session ◽  
Tube Placement ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Endotracheal Tube Placement ◽  
Bronchial Intubation

AbstractIntroduction:The Advanced Cardiac Life Support (ACLS) guidelines were recently updated to include ultrasound confirmation of endotracheal tube (ETT) location as an adjunctive tool to verify placement. While this method is employed in the emergency department under the guidance of the most recent American College of Emergency Physicians (ACEP; Irving, Texas USA) guidelines, it has yet to gain wide acceptance in the prehospital setting where it has the potential for greater impact. The objective of this study to is determine if training critical care medics using simulation was a feasible and reliable method to learn this skill.Methods:Twenty critical care paramedics with no previous experience with point-of-care ultrasound volunteered for advanced training in prehospital ultrasound. Four ultrasound fellowship trained emergency physicians proctored two three-hour training sessions. Each session included a brief introduction to ultrasound “knobology,” normal sonographic neck and lung anatomy, and how to identify ETT placement within the trachea or esophagus. Immediately following this, the paramedics were tested with five simulated case scenarios using pre-obtained images that demonstrated a correctly placed ETT, an esophageal intubation, a bronchial intubation, and an improperly functioning ETT. Their accuracy, length of time to respond, and comfort with using ultrasound were all assessed.Results:All 20 critical care medics completed the training and testing session. During the five scenarios, 37/40 (92.5%) identified the correct endotracheal placements, 18/20 (90.0%) identified the esophageal intubations, 18/20 (90.0%) identified the bronchial intubation, and 20/20 (100.0%) identified the ETT malfunctions correctly. The average time to diagnosis was 10.6 seconds for proper placement, 15.5 seconds for esophageal, 15.6 seconds for bronchial intubation, and 11.8 seconds for ETT malfunction.Conclusions:The use of ultrasound to confirm ETT placement can be effectively taught to critical care medics using a short, simulation-based training session. Further studies on implementation into patient care scenarios are needed.

Neonatal & Paediatric Point Of Care Ultrasound (Pocus): A Novel Standard Practice

2021 ◽  
Vol 8 (3) ◽  
pp. 124-131
Author(s):  
Dr. Abhijit Shinde ◽  
Dr. Sushrut Kumar ◽  
Dr. Sneha Mhaske
Keyword(s):  
Intensive Care ◽  
Endotracheal Tube ◽  
Neonatal Intensive Care ◽  
Point Of Care ◽  
Developed Countries ◽  
Tube Placement ◽  
Point Of Care Ultrasound ◽  
Standard Practice ◽  
Endotracheal Tube Placement ◽  
Growing Body

An ever expanding branch of applications have been developed for ultrasound, including its goal directed use at the bedside, often called point-of-care ultrasound (POCUS). ).  Although neonatologist-performed functional echocardiography has been at the frontline of the worldwide growth of POCUS, a rapidly growing body of evidence has also demonstrated the importance of non-cardiac applications, including guidance of placement of central catheterisation and lumbar puncture, endotracheal tube localisation as well as rapid estimation of the brain, lungs, bladder and bowel.  Ultrasonography has become a pivotal adjunct to the care of neonates in the neonatal intensive care unit (NICU); but a full appreciation for its diagnostic capabilities in the NICU is lacking.(2) Ultrasonography (USG) is no longer the exclusive domain of radiologists and cardiologists. With appropriate training, clinician performed ultrasound (CPU) is now practised widely in obstetrics, emergency medicine and adult intensive care .In many developed countries,it is standard practice in neonatology. (3) In this review, we will discuss neonatal & pediatric point of care ultrasound (POCUS) as a novel standard practice & its clinical application for assessment of the head, heart, lung, gut, bladder, for vascular line localization & for endotracheal tube placement. As new applications and adoption of point-of-care ultrasound continues to gain acceptance in paediatric and neonatal medicine throughout the world, a rapidly growing body of evidence suggests that the result will be faster, safer and more successful diagnosis and treatment of our  patients.

Point-of-Care Ultrasound for Pediatric Endotracheal Tube Placement Confirmation by Advanced Practice Transport Nurses

2020 ◽  
Vol 39 (6) ◽  
pp. 448-453
Author(s):  
Taichi Itoh ◽  
Stephen Gorga ◽  
Andrew Hashikawa ◽  
James Cranford ◽  
Jeffrey Thomas ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Point Of Care ◽  
Tube Placement ◽  
Point Of Care Ultrasound ◽  
Advanced Practice ◽  
Endotracheal Tube Placement

Evaluation of a Semi-Quantitative CO2 Monitor with Pulse Oximetry for Prehospital Endotracheal Tube Placement and Management

2002 ◽  
Vol 17 (1) ◽  
pp. 38-41 ◽  
Author(s):  
Shawn George ◽  
Andrew J. Macnab
Keyword(s):  
Endotracheal Tube ◽  
Life Support ◽  
Advanced Life Support ◽  
Tube Placement ◽  
Success Rates ◽  
Team Members ◽  
Endotracheal Tube Placement ◽  
Alarm Features ◽  
The One ◽  
End Tidal

AbstractObjective:To evaluate three prototype versions of semi-quantitative end-tidal CO2 monitors with different alarm features during prehospital or inter-facility use.Methods:Subjects were 43 adult, non-pregnant patients requiring intubation, or who already were intubated and required transport. Teams at one AirEvac and seven Advanced Life Support (ALS) paramedic stations were trained in the use of the monitors. Team members at each station evaluated each model for eight days. Participants completed questionnaires following each use.Results:The monitors performed properly in all cases, but in one case, vomit in the airway adapter tube prevented obtaining a readout. The monitors aided management in 40 of 43 cases (93%); in one, the monitor reading was reported as variable (between 20 and 30 mmHg) although the teams knew the monitors were semi-quantitative; in another, the monitor was not required, but performed properly; and the third was the one in which vomit in the tube prevented a reading. In 26 of 43 cases (60.4%), the monitor was used to confirm endotracheal tube placement (there were no instances of incorrect placement). In all cases, the devices were used to monitor respiration and oxygen saturation. Alarms were audible in the environment, but only preferred in the AirEvac situation. The “breath beep” feature was useful, particularly in patients in whom chest movements during respiration were difficult to observe.Conclusions:“Breath beeps” were clearly audible and were a useful feature in all prehospital and transport environments, while audible alarms were desired only in the AirEvac situation. Semi-quantitative CO2 detection is valuable in the ALS/AirEvac environment, even for teams with high intubation success rates.

How Well Do Emergency Physicians Document Confirmation of Endotracheal Tube Placement?

2011 ◽  
Vol 26 (4) ◽  
pp. 300-307 ◽  
Author(s):  
Michael P. Phelan ◽  
Jonathan Glauser ◽  
Donald Wickline ◽  
Stefanie Schrump ◽  
Karen Gaber-Patel ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Tube Placement ◽  
Emergency Physicians ◽  
Endotracheal Tube Placement

scholarly journals LO88: Bedside sonography performed by emergency physicians to detect acute appendicitis in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S58
Author(s):  
M. Nicole ◽  
J. Gravel ◽  
M. Desjardins
Keyword(s):  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Tertiary Care ◽  
Training Session ◽  
Lower Sensitivity ◽  
Point Of Care Ultrasound ◽  
Practical Training ◽  
Emergency Physicians ◽  
Primary Analysis ◽  
Bowel Sonography

Introduction: Previous studies have suggested that emergency physicians (EP) highly experienced in point-of-care ultrasound (POCUS) have similar performance to formal ultrasound to identify appendicitis in children. The aim of this study was to evaluate the ability of EP with various levels of POCUS experience to detect appendicitis with POCUS among children visiting a pediatric ED. Methods: A prospective cohort study was conducted in an urban, tertiary care pediatric ED. Children aged 2 to 18 years old who presented to the ED with acute abdominal pain suggesting appendicitis were included. Patients were excluded if they had a history of appendectomy, hemodynamic instability requiring resuscitation, or were transferred with proven diagnosis of appendicitis. Participating EP had various levels of POCUS experience. Four of the 22 physicians were experienced in bowel sonography (EDU 2 level and higher) while the others were inexperienced in bowel sonography (EDU 1). All the participants received a 1-hour didactical and practical training session on appendix ultrasound. The treating physician performed all POCUS following initial physical exam, before further radiological evaluation. Final outcomes were determined by pathology and/or operative reports for surgical cases, and telephone follow-up at 3 weeks for those who did not have surgery. The primary analysis was a simple proportion for sensitivity and specificity for POCUS. Expecting a sensitivity of 80% based on previous studies, we calculated that a sample size of 50 cases would provide a 95%CI ranging from 66 to 90%. Results: We approached 140 patients, of which 121 accepted to participate and were recruited. After excluding 4 patients for missing POCUS data, 117 patients were included in the primary analysis, of which 51 (44%) had appendicitis. Twenty-two EP performed between 1 and 20 POCUS. The POCUS identified 27 out of 51 appendicitis for a sensitivity of 0.53 (95%CI 0.40-0.66). A negative POCUS was reported for 54 out of 66 patients without appendicitis (specificity of 0.82; 95%CI 0.71-0.89). Conclusion: This study shows limited sensitivity and specificity of POCUS when performed by EP with various level of experience for appendicitis in children. While showing lower sensitivity and specificity than previous studies, the inclusion of a large number of physicians solidifies the external validity of our conclusion.

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