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SONO case series: point-of-care ultrasound for intubation confirmation
  1. Michael Gottlieb,
  2. James R O'Brien,
  3. Daven Patel
  1. Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Michael Gottlieb, Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA; MichaelGottliebMD{at}

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Case presentation

A woman in her 60s with a medical history of chronic obstructive pulmonary disease, obstructive sleep apnoea and diabetes mellitus presents for 1 week of worsening shortness of breath and fever despite increasing usage of her home nebulisers. The patient describes daily fever, increased cough and mild achy chest pain. She denies abdominal pain, nausea, vomiting, orthopnoea, leg swelling or other symptoms on review of systems. Her temperature is 38.9°C, HR is 112 beats per minute, BP is 108/72 mm Hg, RR is 28 breaths per minute and pulse oxygenation on room air is 82%.

On examination, you see an ill-appearing woman sitting up in bed in obvious respiratory distress. She is talking in two to three-word sentences. Diffuse wheezing is heard throughout all lung fields with focal rhonchi in the left lower lung field. Cardiac examination is notable for tachycardia with a regular rhythm and no murmurs to auscultation. Capillary refill is less than 2 s. The remainder of the examination is unremarkable.

Despite a brief trial of bilevel positive pressure ventilation with continuous in-line albuterol and ipratropium nebulisers the patient develops confusion and worsening respiratory distress. The decision to intubate is made and sedative and paralytic medications are administered. The laryngoscope is inserted and a Cormack-Lehane grade 3 view is obtained with only the epiglottis visualised. After some difficulty, you are able to pass the endotracheal tube (ETT) over a bougie. You place a linear ultrasound probe over the suprasternal notch and obtain this view (figure 1).

Figure 1

Transtracheal ultrasound.

What are the indications for performing point-of-care ultrasound for intubation confirmation?

Capnography is generally considered the gold standard for intubation confirmation. However, capnography can be falsely positive with hypopharyngeal placement or recent ingestion of a carbonated beverage, as well as falsely …

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  • Handling editor David Metcalfe

  • X @MGottliebMD

  • Contributors MG, JRO'B and DP contributed equally to the drafting and revision of this manuscript. MG takes responsibility for the manuscript as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.