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Aim of Study: Unrecognized one-lung intubations (also known as main-stem intubation) can lead to hypoventilation, atelectasis, barotrauma, and even patient death. Many traditional methods can be employed to detect one-lung intubation; however, each of these methods has limitations and is not consistently reliable in emergency settings. This study aimed to assess the accuracy and timeliness of ultrasound to confirm proper endotracheal intubation., Methods: This was a prospective, single-center, observational study conducted at the emergency department of a national university teaching hospital. Patients received emergency tracheal intubation because of respiratory failure or cardiac arrest. After intubation, bedside ultrasound was performed with a transducer placed on the chest bilaterally at the mid-axillary line, to identify lung sliding over the lungs bilaterally during ventilation. Chest radiography was used as the criterion standard for confirmation of endotracheal tube position., Results: One hundred and fifteen patients needing tracheal intubation were included, and nine (7.8%) had one-lung intubations. The overall accuracy of ultrasound to confirm proper endotracheal intubation was 88.7% (95% confidence interval (CI): 81.6-93.3%). The positive predictive value was 94.7% (95% CI: 87.1-97.9%) in the non-cardiac-arrest group and 100% (95% CI: 87.1-100.0%) in the cardiac-arrest group. The median operating time of ultrasound was 88 s (interquartile range [IQR]: 55.0, 193.0), and of chest radiography was 1349 s (IQR: 879.0, 2221.0) post intubation., Conclusions: In this study, the positive predictive value of bilateral lung sliding in confirming proper endotracheal intubation was high, especially among patients with cardiac arrest. Considerable time advantage of ultrasound over chest radiography was demonstrated., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background/aims: The aim of this study was to evaluate the accuracies of using ultrasonography in determining the levels and causes of gastrointestinal obstruction in the emergency department., Methodology: 229 patients who visited the emergency department with the clinical impression of gastrointestinal obstruction were studied. The gastrointestinal tract was systematically scanned from the anatomically fixed portions to movable portions in the peritoneum by "bisection approximation method". The obstructive levels and possible etiologies were investigated. The finding was correlated with final surgical or further radiological diagnosis., Results: The sensitivity, specificity and accuracy of ultrasonography in determining the obstruction of gastrointestinal tract were 97%, 87% and 93%. In 150 patients with diagnosis of gastrointestinal obstruction by ultrasonography, the accuracies of predicting obstructive levels in the gastric outlet and duodenum, the jejunum and ileum, and the colon were 100%, 74%, and 98% respectively. 67%, 36%, and 78% of obstructive etiologies could be correctly judged in these segments respectively., Conclusions: Ultrasonography is a useful tool in the localization of obstructive levels and the determination of etiologies of gastrointestinal obstruction in the emergency room. It can guide physicians to choose further appropriate confirmation studies.