Introduction

Objectives

The objectives of the study were to develop a standardized ultrasound technique to sonographically identify the cricothyroid membrane (CM) and to evaluate the ability of emergency physicians (EPs) to apply the technique in a cohort of Emergency Department (ED) patients.

Methods

Four cadaveric models were used to develop a technique to accurately identify the CM. Two EPs then sonographically imaged 50 living subjects. Time to visualization of the CM and relevant landmarks, as well as perception of landmark palpation difficulty, were recorded.

Results

Fifty subjects were enrolled, and relevant structures were identified in all participants. The mean time to visualization of the CM was 24.32 ± 20.18 seconds (95% confidence interval, 18.59-30.05 seconds). Although a significant relationship between palpation difficulty and body mass index was noted, body mass index did not impact physician ability to identify the CM.

Conclusions

Emergency physicians were able to develop and implement a reliable sonographic technique for the identification of anatomy relevant to performing an emergent cricothyrotomy.

Background

Methods

This case-controlled study consisted of 106 consecutive patients, 43 with brain infarction (BI), 11 with brain hemorrhage (ICH), 52 with SAH, and a 43-member control group. We investigated whether there was a statistical correlation between these 3 groups and the control group. The relations among the 3 groups were also examined. Comparisons among groups were done with analysis of variance.

Results

Mean serum IMA levels were 0.280 ± 0.045 absorbance units (ABSU) for BI patients, 0.259 ± 0.053 ABSU for ICH patients, 0.243 ± 0.061 ABSU for SAH patients, and 0.172 ± 0.045 ABSU for the control group.

There was a statistically significant difference between the mean IMA levels of BI, ICH, and SAH patients and the mean control patient IMA levels (P < .0001).

Conclusions

Ischemia-modified albumin levels are high in cerebrovascular diseases. Ischemia-modified albumin measurement can also be used to distinguish SAH from BI during the acute phase of cerebrovascular event in the emergency department.