Here’s how to do it under ultrasound guidance, taught by Josh Holden:
Tag: ultrasound
-
Why cricoid pressure doesn’t work (probably)
by Josh Holden FACEM CCPU
Ever wondered why we don’t use cricoid pressure in ED? After all, compressing the oesophagus between the larynx and C5 vertebral body should stop any breakfast from coming up the wrong way quite nicely?
Check out the ultrasound video below to see the whereabouts of Jonathon Au’s foodpipe, and what might happen (other than ruining your intubation view) if you give his larynx a choke hold:As you can see his oesophagus lies lateral to the trachea, not below it as commonly assumed.
This seems to be completely normal. Dynamic MRI studies demonstrate that application of pressure to the cricoid cartilage displaces the oesophagus laterally instead of occluding it (Smith 2003, Boet 2012). An ultrasound study demonstrated similar findings: in 60% of patients the oesophagus was lateral to the airway and cricoid pressure led to displacement rather than occlusion in all patients. (Tsung 2012). Old news then… -
Education Session: Shock
Knowledge Review Quiz here
Cases we discussed are here
Causes of elevated LACTATES
Venue Ultrasound : Auto VTI Demo
Femoral vs radial arterial lines, and non-invasive vs invasive BP measurement (PulmCrit): http://emcrit.org/pulmcrit/a-line/
Other references:
1. Perner A, Cecconi M, Cronhjort M, Darmon M, Jakob SM, Pettilä V, et al. Expert statement for the management of hypovolemia in sepsis. Intensive Care Med. 2018 Apr 25;44(6):791–8.
2. Marik PE. Fluid Responsiveness and the Six Guiding Principles of Fluid Resuscitation. Critical Care Medicine. 2016 Oct;44(10):1920–2.
3. Dynamic LVOTO: https://echo.anesthesia.med.utah.edu/dynamic-obstruction/
