Name: image acquisition using portable sonography for emergency airway management
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这些研究得到了乔治华盛顿大学机构审查委员会（IRB # NCR203147）的批准。下面描述的所有程序（和图中所示）的研究对象是一名 32 岁的男性，他完全知情同意研究和发布去识别化的图像。纳入标准包括任何接受气道管理或麻醉护理的患者（特别是那些具有困难气道特征的患者），排除标准将包括任何不同意此手术的患者。
1.区分食管插管与气管插管
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	<li>Krishnan, S., Bronshteyn, Y. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+diagnostic+point-of-care+ultrasound+in+preoperative+optimization:+a+narrative+review.">Role of diagnostic point-of-care ultrasound in preoperative optimization: a narrative review.</a> International Anesthesiology Clinics. 60 (1), 64-68 (2022).</li><li>Pulton, D., Feinman, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hocus+POCUS:+Making+barriers+to+perioperative+point-of-care+ultrasound+disappear.">Hocus POCUS: Making barriers to perioperative point-of-care ultrasound disappear.</a> Journal of Cardiothoracic and Vascular Anesthesia. 33 (9), 2419-2420 (2019).</li><li>Ford, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Confirming+tracheal+intubation+-+a+simple+manoeuvre.">Confirming tracheal intubation - a simple manoeuvre.</a> Canadian Anaesthetists Society Journal. 30 (2), 191-193 (1983).</li><li>Howells, T. H., Riethmuller, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Signs+of+endotracheal+intubation.">Signs of endotracheal intubation.</a> Anaesthesia. 35 (10), 984-986 (1980).</li><li>Honardar, M. R., Posner, K. L., Domino, K. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Delayed+detection+of+esophageal+intubation+in+anesthesia+malpractice+claims:+Brief+report+of+a+case+series.">Delayed detection of esophageal intubation in anesthesia malpractice claims: Brief report of a case series.</a> Anesthesia &amp; Analgesia. 125 (6), 1948-1951 (2017).</li><li>Farrokhi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Screening+performance+characteristics+of+ultrasonography+in+confirmation+of+endotracheal+intubation;+a+systematic+review+and+meta-analysis.">Screening performance characteristics of ultrasonography in confirmation of endotracheal intubation; a systematic review and meta-analysis.</a> Archives of Academic Emergency Medicine. 9 (1), 68 (2021).</li><li>Apfelbaum, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=American+Society+of+Anesthesiologists+practice+guidelines+for+management+of+the+difficult+airway.">American Society of Anesthesiologists practice guidelines for management of the difficult airway.</a> Anesthesiology. 136 (1), 31-81 (2022).</li><li>Kristensen, M. S., Teoh, W. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+identification+of+the+cricothyroid+membrane:+the+new+standard+in+preparing+for+front-of-neck+airway+access.">Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access.</a> British Journal of Anaesthesia. 126 (1), 22-27 (2021).</li><li>Oliveira, K. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determining+the+amount+of+training+needed+for+competency+of+anesthesia+trainees+in+ultrasonographic+identification+of+the+cricothyroid+membrane.">Determining the amount of training needed for competency of anesthesia trainees in ultrasonographic identification of the cricothyroid membrane.</a> BMC Anesthesiology. 17 (1), 74 (2017).</li><li>Roth, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bedside+tests+for+predicting+difficult+airways:+an+abridged+Cochrane+diagnostic+test+accuracy+systematic+review.">Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review.</a> Anaesthesia. 74 (7), 915-928 (2019).</li><li>Andruszkiewicz, P., Wojtczak, J., Sobczyk, D., Stach, O., Kowalik, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+and+validity+of+sonographic+upper+airway+evaluation+to+predict+difficult+laryngoscopy.">Effectiveness and validity of sonographic upper airway evaluation to predict difficult laryngoscopy.</a> Journal of Ultrasound Medicine. 35 (10), 2243-2252 (2016).</li><li>Kristensen, M. S., Teoh, W. H., Graumann, O., Laursen, C. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonography+for+clinical+decision-making+and+intervention+in+airway+management:+from+the+mouth+to+the+lungs+and+pleurae.">Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae.</a> Insights Imaging. 5 (2), 253-279 (2014).</li><li>Carsetti, A., Sorbello, M., Adrario, E., Donati, A., Falcetta, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Airway+ultrasound+as+predictor+of+difficult+direct+laryngoscopy:+A+systematic+review+and+meta-analysis.">Airway ultrasound as predictor of difficult direct laryngoscopy: A systematic review and meta-analysis.</a> Anesthesia &amp; Analgesia. 134 (4), 740-750 (2022).</li><li>Mart&#237;nez-Garc&#237;a, A., Guerrero-Orriach, J. L., Pino-G&#225;lvez, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonography+for+predicting+a+difficult+laryngoscopy.+Getting+closer.">Ultrasonography for predicting a difficult laryngoscopy. Getting closer.</a> Journal of Clinical Monitoring and Computing. 35 (2), 269-277 (2021).</li><li>Chen, H. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Parapharyngeal+fat+pad+area+at+the+subglosso-supraglottic+level+is+associated+with+corresponding+lateral+wall+collapse+and+apnea-hypopnea+index+in+patients+with+obstructive+sleep+apnea:+a+pilot+study.">Parapharyngeal fat pad area at the subglosso-supraglottic level is associated with corresponding lateral wall collapse and apnea-hypopnea index in patients with obstructive sleep apnea: a pilot study.</a> Scientific Reports. 9 (1), 17722 (2019).</li><li>Mehta, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Usefulness+of+preoperative+point-of-care+ultrasound+measurement+of+the+lateral+parapharyngeal+wall+to+predict+difficulty+in+mask+ventilation.">Usefulness of preoperative point-of-care ultrasound measurement of the lateral parapharyngeal wall to predict difficulty in mask ventilation.</a> Baylor University Medical Center Proceedings. 35 (5), 604-607 (2022).</li><li>Chou, H. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+tracheal+ultrasonography+for+confirmation+of+endotracheal+tube+placement+during+cardiopulmonary+resuscitation.">Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation.</a> Resuscitation. 84 (12), 1708-1712 (2013).</li><li>Singh, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+sonography+for+airway+assessment:+an+observational+study.">Use of sonography for airway assessment: an observational study.</a> Journal of Ultrasound Medicine. 29 (1), 79-85 (2010).</li><li>Kristensen, M. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomised+cross-over+comparison+of+the+transverse+and+longitudinal+techniques+for+ultrasound-guided+identification+of+the+cricothyroid+membrane+in+morbidly+obese+subjects.">A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects.</a> Anaesthesia. 71 (6), 675-683 (2016).</li><li>Werner, S. L., Jones, R. A., Emerman, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+assessment+of+the+epiglottis.">Sonographic assessment of the epiglottis.</a> Academic Emergency Medicine. 11 (12), 1358-1360 (2004).</li><li>Fernandez-Vaquero, M. A., Charco-Mora, P., Garcia-Aroca, M. A., Greif, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preoperative+airway+ultrasound+assessment+in+the+sniffing+position:+a+prospective+observational+study.">Preoperative airway ultrasound assessment in the sniffing position: a prospective observational study.</a> Brazilian Journal of Anesthesiology. , (2022).</li><li>Bilici, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Submental+ultrasonographic+parameters+among+patients+with+obstructive+sleep+apnea.">Submental ultrasonographic parameters among patients with obstructive sleep apnea.</a> Otolaryngology-Head and Neck Surgery. 156 (3), 559-566 (2017).</li><li>Mahmood, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perioperative+ultrasound+training+in+anesthesiology:+A+call+to+action.">Perioperative ultrasound training in anesthesiology: A call to action.</a> Anesthesia and Analgesia. 122 (6), 1794-1804 (2016).</li><li>Ramsingh, D., Bronshteyn, Y. S., Haskins, S., Zimmerman, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perioperative+point-of-care+ultrasound:+From+concept+to+application.">Perioperative point-of-care ultrasound: From concept to application.</a> Anesthesiology. 132 (4), 908-916 (2020).</li><li>Mishra, P. R., Bhoi, S., Sinha, T. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Integration+of+point-of-care+ultrasound+during+rapid+sequence+intubation+in+trauma+resuscitation.">Integration of point-of-care ultrasound during rapid sequence intubation in trauma resuscitation.</a> Journal of Emergencies, Trauma, and Shock. 11 (2), 92-97 (2018).</li><li>Bhoi, S., Mishra, P. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Integration+of+point-of-care+sonography+during+rapid+sequence+intubation+in+trauma+resuscitation:+will+it+make+a+difference.">Integration of point-of-care sonography during rapid sequence intubation in trauma resuscitation: will it make a difference.</a> The American Journal of Emergency Medicine. 34 (2), 330 (2016).</li><li>Thomas, V. K., Paul, C., Rajeev, P. C., Palatty, B. U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+ultrasonography+in+confirming+endotracheal+tube+placement+in+an+emergency+setting.">Reliability of ultrasonography in confirming endotracheal tube placement in an emergency setting.</a> Indian Journal of Critical Care Medicine. 21 (5), 257-261 (2017).</li><li>Fiadjoe, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound-guided+tracheal+intubation:+a+novel+intubation+technique.">Ultrasound-guided tracheal intubation: a novel intubation technique.</a> Anesthesiology. 117 (6), 1389-1391 (2012).</li><li>Hung, K. C., Chen, I. W., Lin, C. M., Sun, C. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+between+ultrasound-guided+and+digital+palpation+techniques+for+identification+of+the+cricothyroid+membrane:+a+meta-analysis.">Comparison between ultrasound-guided and digital palpation techniques for identification of the cricothyroid membrane: a meta-analysis.</a> British Journal of Anaesthesia. 126 (1), 9-11 (2021).</li><li>Siddiqui, N., Yu, E., Boulis, S., You-Ten, K. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+is+superior+to+palpation+in+identifying+thecricothyroid+membrane+in+subjects+with+poorly+defined+neck+landmarks:+A+randomized+clinical+trial.">Ultrasound is superior to palpation in identifying thecricothyroid membrane in subjects with poorly defined neck landmarks: A randomized clinical trial.</a> Anesthesiology. 129 (6), 1132-1139 (2018).</li><li>Lavelle, A., Drew, T., Fennessy, P., McCaul, C., Shannon, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+cricothyroid+membrane+identification+using+ultrasound+and+palpation+techniques+in+obese+obstetric+patients:+an+observational+study.">Accuracy of cricothyroid membrane identification using ultrasound and palpation techniques in obese obstetric patients: an observational study.</a> International Journal of Obstetric Anesthesia. 48, 103205 (2021).</li><li>Altun, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+ultrasonography+in+determining+the+cricothyroid+membrane+localization+in+the+predicted+difficult+airway.">Role of ultrasonography in determining the cricothyroid membrane localization in the predicted difficult airway.</a> Ulus Travma Acil Cerrahi Derg. 25 (4), 355-360 (2019).</li><li>Cho, S. 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2018年，心血管麻醉师协会的领导层呼吁采取行动，进行“麻醉学围手术期超声培训”23。值得注意的是，这些领导人强调，POCUS教育应成为麻醉学培训计划的重要组成部分。最近，麻醉学专家进一步解释了POCUS在围手术期患者护理的各个方面（包括气道管理）中的效用和必要性24。专家强调，麻醉学界的领导者必须倡导POCUS的教育，并通过指南和特定的认证流程?...

便携式超声检查在患者的围手术期护理中具有明显的实用性。它的可及性和缺乏侵入性是导致即时超声（POCUS）迅速纳入手术患者临床护理的好处1，2。随着POCUS在围手术期领域不断寻找新的适应症，有几个既定的适应症与传统的临床检查相比具有明显的益处。在这种方法论文中，我们回顾了最近的发现，并展示了如何将POCUS整合到临床实践或气道管理中。
未检测到的食管插管可导致显著的并发症发生率和死亡率;因此，立即识别食管插管并将插管置于气管内位置以避免灾难性的呼吸损伤至关重要。气管插管的传统确认依赖于临床检查，例如听诊双侧呼吸音和胸位上升3，4。即使在美国麻醉医师协会 （ASA） 将潮气末 CO2 作为识别气管插管的必要监测器之后，仍然存在未检测到食管插管的病例，导致显着的发病率和死亡率5。将气管超声检查纳入插管程序的一个主要好处是可以立即识别食管插管，并且可以在气管中确认管子的实时、直接可视化。在最近的一项荟萃分析中，气管内确认的汇总敏感性和特异性分别为 98% 和 94%，说明该技术具有卓越的诊断准确性6。在该方法论文中，将展示一个视频示例，说明管子被错误地放置在食道中，立即识别出这种并发症，并将管子正确放置在气管中。这突出了POCUS在插管过程中允许的实时视觉优势。
尽管声门上气道和视频喉镜检查取得了进展，但在“不能插管，不能充氧”的情况下，手术气道可能仍然是挽救生命的必需品。更新后的ASA困难气道指南强调，如果需要挽救生命的侵入性气道，则必须由训练有素的专家尽快执行该程序7。如果需要进行环甲膜切开术，则需要确定正确的解剖结构以防止进一步的并发症。利用超声检查来可视化环甲膜（CTM）的解剖结构是一种快速有效的技术，如果担心气道困难，现在建议在术前使用8。这种技术可以以相对快速的方式教授，学习者在简短的 2 小时教程和 20 次专家指导扫描9 后几乎获得了完全的能力。在这种方法论文中，将展示两种使用POCUS识别CTM的技术，以期进一步教育任何常规进行气道管理的医疗保健提供者。
患者气道的术前评估包括传统的床旁临床检查（例如Mallampati评分、张口、宫颈活动度等）。这些评估存在几个问题。第一个可能也是最突出的是，它们在预测困难的气道情况方面不是很准确10。此外，这些测试需要患者参与，这在所有临床情况下（例如在创伤或精神状态改变的情况下）都是不可能的。
术前气道超声测量显示，预测气管插管放置困难的准确性有所提高11，12。已经测量和分析了不同水平的颈部前软组织厚度，作为插管困难的预测。皮肤到会厌之间距离的超声测量似乎具有迄今为止确定的最佳诊断准确性13。当添加到传统的床边检查中时，这种测量也被证明可以大大提高预测能力14。本文解释了如何使用POCUS测量皮肤到会厌的距离并将其纳入术前气道检查，以帮助医疗保健提供者更好地预测困难的气道情况。
此外，研究人员已开始确定表明面罩通气困难的解剖结构。一种这样的解剖结构是咽侧壁，其厚度（LPWT）已被证明对应于阻塞性睡眠呼吸暂停（OSA）的严重程度和呼吸暂停-低通气指数15。初步数据还表明，术前对LPWT的测量为面罩通气的困难提供了证据16。本文和相关视频将演示如何通过便携式超声检查获取LPWT，以评估患者OSA的严重程度以及面罩通气困难的可能性。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>High Frequency Ultrasound Probe (HFL38xp)</td>
			<td>SonoSite (FujiFilm)</td>
			<td>P16038</td>
			<td></td>
		</tr>
		<tr>
			<td>Low Frequency Ultrasound Probe (C35xp)</td>
			<td>SonoSite (FujiFilm)</td>
			<td>P19617</td>
			<td></td>
		</tr>
		<tr>
			<td>SonoSite X-porte Ultrasound</td>
			<td>SonoSite (FujiFilm)</td>
			<td>P19220</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound Gel</td>
			<td>AquaSonic</td>
			<td>PLI 01-08</td>
			<td></td>
		</tr>
	</tbody>
</table>

image acquisition using portable sonography for emergency airway management

随着便携式超声检查的日益普及和可及性，便携式超声检查已被迅速调整，不仅用于改善患者的围手术期护理，而且还用于解决在气道管理中使用超声的潜在益处。床旁超声（POCUS）的好处包括其便携性，使用速度快，以及患者没有侵入性或暴露于其他成像方式的辐射。
气道 POCUS 的两个主要适应证包括确认气管插管和在需要手术气道时识别环甲膜。在本文中，描述了使用超声确认气管插管和相关解剖结构的技术，以及相关的超声图像。此外，还回顾了环甲膜解剖结构的识别以及超声采集适当的图像以执行此过程。
未来的进展包括利用气道POCUS来识别可能表明气道管理困难的患者特征。传统的床旁临床检查充其量只有公平的预测值。增加超声气道评估有可能提高这种预测准确性。本文介绍了使用POCUS进行气道管理，初步证据表明，这提高了预测困难气道的诊断准确性。鉴于气道POCUS的局限性之一是它需要熟练的超声医师，并且图像分析可能取决于操作人员，本文将为标准化气道超声检查的技术方面提供建议，并促进利用超声检查进行气道管理的进一步研究。该协议的目标是教育研究人员和医疗卫生专业人员，并推进气道POCUS领域的研究。

通过利用气管的实时超声探头可视化，协议步骤1中的指示使气道管理人员能够快速安全地保护气道。通过按照超声可视化下放置在适当气管内位置的步骤，快速识别气管插管并将其从食道中取出（图1，图2和图3）。这种技术的优点是使用超声波实时查看气管插管在气管中的位置。
在使用超声波?...

Watch this Scientific Journal Video about Image Acquisition using Portable Sonography for Emergency Airway Management at JoVE.com

Image Acquisition using Portable Sonography for Emergency Airway Management

即时超声（POCUS）越来越多地用于气道管理。本文介绍POCUS的一些临床应用，包括区分气管内插管和食管插管，在需要手术气道时识别环甲膜，以及测量颈部前软组织以预测困难的气道管理。

使用便携式超声采集图像进行紧急气道管理

With its increasing popularity and accessibility, portable ultrasonography has been rapidly adapted not only to improve the perioperative care of ...

气道POCUS的使用在急诊或困难的气道管理中有几个适应症。在本视频中，我们将回顾其中一些适应症以及如何获取有效所需的超声图像。使用气道POCUS的主要优点是它是一种快速，易于访问且无创的成像方式，可用于高敏锐度临床情况。虽然这些协议可以相对快速地学习，但我建议你在非紧急情况下练习它们，以便变得舒适和高效。这是Erica Chemtob博士，我们部门的居民演示了该程序。首先通过在探头换能器上放置一层超声凝胶来制备高频线性超声探头。从触摸屏上的探头菜单中选择线性探头，然后从下拉菜单中指定 MSK。现在，通过按触摸屏左下角的2D按钮将超声波置于扫描模式。诱导全身麻醉后，将探头放置在患者前颈部中线的横向位置，刚好是头颅到胸骨上切迹。识别气管中线，注意气管外侧的收缩食管。为了进一步的解剖学确认，侧向扫描以识别颈动脉和颈内静脉。此外，检查气管的高回声后侧是否因气管插管而消失，留下子弹形的特征性声学阴影。要进行 CTM 识别，请将患者置于仰卧位，伸展颈部。准备超声探头，并根据平均大小的患者将探头放置在大约 1.5 至 2 厘米的深度，因为 CTM 在颈部较浅。然后，通过将线性高频探头放置在患者颈部的矢状面（仅靠近甲状腺软骨的尾部）来执行CTM识别的第一种方法。甲状腺软骨在扫描的颅侧表现为浅表低回声结构，并投射出声影。现在，找到环状软骨，它位于尾部位置，看起来低回声。使用下面的空气粘膜界面，识别位于这两个结构之间的CTM，它表现为沿气管长度延伸的高回声线。为了进一步确认，请尾部扫描以找到气管环，该环将显示为一串高回声珠子。或者，CTM也可以通过在甲状腺软骨水平的横向平面上放置一个线性高频探头来定位，该探头看起来是高回声的，并投射出黑色三角形的声影，尖端是最浅的。沿尾部方向扫描，直到黑色三角形消失，因为甲状腺软骨结束，CTM开始。将其识别为空气粘膜界面，显示为具有混响效果的亮白线。继续沿尾部方向扫描，直到CTM结束并出现环状软骨。环状软骨将表现为气管周围的低回声带。一旦确定了环状体，CTM的下边界也就被定位了。为了确保确定了正确的解剖结构，请反向这些步骤并在头颅方向扫描;再次识别CTM和甲状腺软骨。一旦确定了这些标志，在患者身上标记CTM位置。要测量皮肤到会厌的距离，请放置患者并准备探头和超声，如前所述。将高频线性探头放置在甲状腺膜水平的颈部前部横向位置。识别会厌，即舌骨和甲状腺软骨中间的低回声结构。会厌的喉表面形成代表空气粘膜界面的高回声线。如果会厌前缘未明确，则向任一方向倾斜探头。注意回声前声门空间。要测量皮肤到会厌的距离，请通过触摸触摸屏底部的大冻结按钮来冻结图像。接下来，选择屏幕右侧的蓝色距离按钮。要测量LPWT，请将曲线低频探头放置在乳突下方的冠状方向上，并与颈动脉对齐。然后，使用多普勒血流通过按屏幕左下角的 C 按钮来识别颈动脉。用手指在触摸屏上，将黄色框移到颈动脉脉管系统上，并通过记录搏动血管流动来识别颈动脉。要测量 LPWT，请如前所述冻结图像。将一个光标放在颈动脉的下缘，将第二个光标放在气道的前侧。LPWT 将显示在屏幕左上角的灰色框中。LPW的超声测量显示，基于呼吸暂停-低通气指数，LPWT与OSA的严重程度相关。必须记住，在紧急气道管理场景中，时间至关重要，可能会影响患者的预后。进行气道超声检查的提供者必须熟练掌握图像采集和解释，以便在这些情况下受益。

Research

JoVE Journal

Medicine

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

利用视觉和叙事方法，以实现公平的进程中，在临床护理

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

科研

医学

Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management

病人体温控制的食管传热及靶温管理

Controlling patient temperature is important for a wide variety of clinical conditions. Cooling to normal or below normal body temperature is often ...

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

使用柔性插管内窥镜作为猪安全气道管理的标准化模型的气管插管

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava

一种下腔静脉超声评估的图像采集方法

Over the past several decades, clinicians have incorporated several applications of diagnostic point-of-care ultrasound (POCUS) into medical ...

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

下肢近端深静脉血栓形成的即时超声筛查

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

Troubleshooting FoCUS Image Acquisition: Patient Positioning, Transducer Manipulation, and Image Optimization

FoCUS 图像采集故障排除：患者定位、换能器操作和图像优化

Focused cardiac ultrasound (FoCUS) is a limited, clinician-performed application of echocardiography to add real-time information to patient care. These ...

Point-of-Care Lung Ultrasound in Adults: Image Acquisition

成人床旁肺部超声：图像采集

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally ...

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

一种改进的超声算法，用于危重新生儿危及生命的急症图像采集

The use of routine point-of-care ultrasound (POCUS) is increasing in neonatal intensive care units (NICUs), with several centers advocating for 24 h ...

Exploring Quantitative Autofluorescence in Age-Related Macular Degeneration

A Workflow to Quantitatively Determine Age-Related Macular Degeneration Lesion-Specific Variations in Fundus Autofluorescence

Understanding Age-Related Macular Degeneration Pathophysiology with QAF Workflow (Video) | JoVE

定量确定年龄相关性黄斑变性病变性病变性眼底自发荧光特异性变化的工作流程

Fundus autofluorescence (FAF) imaging allows the noninvasive mapping of intrinsic fluorophores of the ocular fundus, particularly the retinal pigment ...

Laryngeal Mask Airway (LMA) Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway (SGA)

Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA

使用非充气声门上气道 （SGA） 将喉罩气道 （LMA） 放置在新生儿患者模拟器中

The effective delivery of positive pressure ventilation (PPV) can be challenging during neonatal resuscitation. Achieving a patent airway through an ...