J Korean Soc Emerg Med.
2007 Jun;18(3):227-233.
The Availability of Bedside Ultrasonography in Confirming Endotracheal Tube Placement in the Emergency Department
- Affiliations
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- 1Department of Emergency Medicine, College of Medicine, Inha University, Incheon, Korea. zii-hye@hanmail.net
- 2Department of Occupational & Environmental Medicine, College of Medicine, Inha University, Incheon, Korea.
- 3Department of Radiology, College of Medicine, Inha University, Incheon, Korea.
Abstract
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PURPOSE: The goal of this study was to determine the suitability of ultrasonography for detecting endotracheal tube placement in the emergency department.
METHODS
Emergency physicians examined patients immediately following intubation or after intubated patients were transferred. A linear ultrasound transducer was placed transversely on the cricothyroid membrane and suprasternal notch in order to check for the "comet head and tail sign"and "double ring sign", and a sagittal view of the neck was also obtained in order to look for the "bold parallel lines sign". Subsequently, simple thoracic sonography and color doppler sonography were used to check for the "lung sliding sign". The examiner evaluated whether the tube was placed in trachea, the esophagus, or the right main bronchus. The accuracy of ultrasonography was calculated, and the required time for ultrasonography was checked.
RESULTS
One hundred ten patients were enrolled in the study. The endotracheal tube was placed in the trachea in 107 patients, in the esophagus in 2 patients, and in the right main bronchus in 1 patient. The sensitivity and specificity of ultrasonography were 100%. The bold parallel lines sign and lung sliding sign proved to be good indicators of endotracheal tube placement. The average required time for ultrasonography was 28.6+/-5.8 seconds. It was difficult to determine tube placement by thoracic ultrasonography in patients with pneumothorax, hemothorax, pleural effusion, or empyema.
CONCLUSION
Ultrasonography is well suited for confirming endotracheal tube placement in the emergency department.
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