The feasibility of Determining the Position of an Endotracheal Tube in Neonates by using Bedside Ultrasonography Compared with Chest Radiographs

Background. Neonates in our neonatal intensive care unit (NICU) receive a large amount of radiation with X-rays (XRs) being done daily; even more often with reintubation; repositioning of endotracheal tubes (ETTs) and confirmation thereof; which has been our NICU policy for many years. Objective. To investigate the feasibility of determining the position of ETTs in neonates by using bedside ultrasonography (BUS); and to compare the results with those obtained from chest XR (CXR) findings. Methods. A prospective; cross-sectional study was done on intubated neonates in the NICU at Universitas Academic Hospital; Bloemfontein; to determine the position of ETTs by using BUS.Results. Thirty intubated patients included in this study had a median age of 13.5 days and a median weight of 1.6 kg. Ninety-three per cent of ETT placements were considered optimal when visualised by BUS; while 73.3 were considered to be placed optimally when CXR was viewed. When CXR and BUS findings were compared regarding optimal placing; the agreement was poor (?=0.10; 95 confidence interval -0.2 - 0.4). In four patients; the distance from the aortic arch to the tip of the ETT was outside the expected range of 1.5 - 2.2 cm: in two patients it was 1.5 cm (6.7) and in the other two 2.25 cm (6.7). BUS measurements were done mainly in extended head (53.3) or neutral (36.7) position. Conclusion. Although poor agreement between CXR and BUS findings was obtained; possibly because of handling of patients with secondary shifting of ETTs; BUS was found not to be comparable with CXR; but an alternative feasible method to determine the optimal position of ETTs in the trachea in neonates when using other reference points; with the added advantage of no radiation exposure

The imaging of stab injuries.

In the trauma unit of the Bloemfontein Academic Complex, the total number of stab wounds seen represents approximately 70.5% of penetrating injuries, which is 6.4% of 5004 trauma cases seen in a period of 1 year. The other cases are gunshot wounds and pedestrian or motor vehicle accidents. Specific guidelines and protocols are followed for penetrating trauma management. All imaging modalities are utilized, with chest radiography the mainstay of thoracic imaging in patients having sustained sharp penetrating chest injuries. Computed tomography (CT) is being used more frequently as the primary imaging modality in the evaluation of hemodynamically stable patients with penetrating injuries. The improved speed of data acquisition and superior image reconstruction of multidetector CT (MDCT) has further driven this change in imaging approach. Although digital subtraction angiography (DSA) has been the reference standard for the diagnosis of traumatic vascular injuries, it is giving way to faster, less invasive, and less personnel-intensive imaging techniques, e.g., MDCT angiography. Given the fact that we work in an academic environment and that we have a dedicated interventional unit, arteriography is still frequently performed and still has its place as the "gold standard" in the diagnosis of vascular injuries. Penetrating chest injuries suspected of traversing the mediastinum or extending near the posterior mediastinal structures dictate esophageal and tracheal evaluation. Although radiology has a role to play, direct visualization (esophagoscopy, bronchoscopy) remains the most reliable method of excluding injuries to these structures. Transthoracic ultrasound (echocardiography) has become indispensable in helping to evaluate injuries to the heart and the ascending and descending aortas. More recent work has demonstrated that ultrasonography can also be used to detect hemothoraces and pneumothoraces with accuracy.