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J Korean Soc Emerg Med > Volume 26(5); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(5): 458-465.
기관내삽관을 시행한 환자를 대상으로 한 초음파 유도 윤상갑상막 확인법과 해부학 적 구조물 촉지 윤상갑상막 확인법의 비교
양햇빛, 조영순, 최재형, 임훈
순천향대학교 부천병원 응급의학교실
The Comparison of Ultrasound Guided Cricothyroid Membrane Identification Method and Anatomical Landmark Palpation Cricothyroid Membrane Identification Method in Intubated Patients
Hae Bit Yang, Young Soon Cho, Jae Hyung Choi, Hoon Lim
Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Bucheon, Gyeonggido, Korea
Correspondence  Young Soon Cho ,Tel: 032) 621-6369, Fax: 032) 327-3549, Email: emer0717@nate.com,
Received: June 15, 2015; Revised: June 16, 2015   Accepted: July 24, 2015.  Published online: October 30, 2015.
ABSTRACT
Purpose:
Cricothyroidotomy had a high failure rate. Ultrasound-guided cricothyroid membrane (CTM) identification may be more accurate and easier than anatomical landmark palpation. The purpose of this study was to compare the accuracy of ultrasound-guided CTM identification method (ultrasound method) and anatomical landmark palpation CTM identification method (palpation method) in patients who were intubated in an emergency medical center.
Method:
Using fluorescent invisible ink, the emergency physician was asked to mark the center of the CTM with the patient by palpation method. After 5 minutes, the participant found the CTM using the ultrasound method and drew a cross with a blue pen. An emergency medicine specialist or senior resident identified the actual center of the CTM with ultrasound and drew a cross with a black pen. The distance between the actual and estimated center of the CTM was measured. Participants measured the ease of use of each method using a 0~10 visual analog scale (VAS).
Results:
Nineteen patients were enrolled and 38 tests were performed. Both first and second year emergency medicine residents showed that identifying the CTM was more difficult in cases of using the palpation method compared with the ultrasound method. VAS score was 3.0 (1.0-5.0) and 4.0 (2.0-8.0), respectively (p=0.006). Using the ultrasound method and another method, the horizontal length differences were 1.0 mm (IQR 0-2.0) vs. 2 mm (IQR 1.0-3.0) (p<0.001) and the vertical length differences were 1.5 mm (IQR 0-2.0) vs. 3.0 mm (IQR 1.0-9.3), respectively (p<0.001).
Conclusion:
Using the ultrasound method is an easier and more accurate way to find the center of the CTM compared with the palpation method in patients who were intubated in an emergency medical center.
Key words: Cricothyroid, Ultrasonography, Airway management, Intubation
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