Use of Handheld Point-of-Care Ultrasound in Emergency Airway Management

Benefits of incorporating point of care ultrasound in the anaesthetic management of a dog requiring surgical correction of traumatic zygomatic fracture causing pseudoankylosis and severe dental malocclusion

“…POCUS was originally developed in human medicine to allow for diagnostic investigations whenever a patient was being treated; however, it has now been introduced as a promising technology to improve patient safety in EAM. 6,8 It is now used worldwide in the emergency and critical care setting of human and veterinary patients for rapid assessment following trauma. [9][10][11] This novel strategy has many advantages; it provides real-time images, it is noninvasive and direct, colour Doppler can be used for blood vessel visualisation and associated anatomical localisation, it is repeatable, reliable and rapid.…”

“…Upper airway POCUS for EAM can facilitate rapid screening for difficult laryngoscopy, identify important sonoanatomy (the laryngeal cartilages, cricothyroid membrane, tracheal cartilages and oesophagus), assess for increased aspiration risk and provide confirmation of ETT positioning. 6,8 The American Heart Association's 2015 guidelines for human patients was updated to include the use of ultrasound as an ETT placement verification method during advanced cardiovascular life support. 12 In the case described here, severe dental malocclusion was irreversibly complete with no ability to visualise the larynx, and therefore the authors successfully utilised POCUS for airway assessment and retrograde intubation.…”

“…Delays or difficulties in securing an airway have led to the development of algorithms and techniques to decrease the associated morbidity and mortality rates 6,7 in the emergent situation. POCUS was originally developed in human medicine to allow for diagnostic investigations whenever a patient was being treated; however, it has now been introduced as a promising technology to improve patient safety in EAM 6,8 . It is now used worldwide in the emergency and critical care setting of human and veterinary patients for rapid assessment following trauma 9–11 .…”

What is new in airway management

“…When compared to traditional USG machines, handheld point-of-care ultrasound (POCUS) provides several potential benefits (lower cost, portability, easier cleaning) in emergency airway management but still lags behind in image quality [ 17 ]. However, POCUS shows promise to facilitate rapid screening for difficult laryngoscopy, identifying the cricothyroid membrane, assessment for increased aspiration risk, as well as providing confirmation of ETT placement [ 17 ]. Furthermore, a case report in this journal by Kundra et al described ultrasound-guided tracheal intubation with a styleted ETT as a useful option to the secure the airway in patients with limited head extension [ 18 ].…”

One nation, one roof, one set of preoperative investigations……The guidelines overcoming a diverse demography!

“…[ 17 18 ] It is likely that in the near future, the handheld point-of-care (POC) ultrasound will be used routinely to facilitate preoperative rapid screening of the airway and spine. [ 19 ]…”