CS - Head and neck: surface anatomy and ultrasound scanning

Question 1

What is Point-of-care Ultrasound (POCUS) and its uses?

Answer 1

Point-of-care Ultrasound (POCUS);
- Use of portable ultrasound devices at the bedside
- By trained healthcare providers
- To perform a goal-directed examination

Why?;
- Aid the diagnostic process (answer a specific question)
- Guide an invasive procedure

Question 2

What central venous access can we get in the neck ?

Answer 2

Remember aseptic technique !

Neck access sites;
- Internal jugular vein
- Subclavian vein
- External jugular vein

Veins in close proximity to important anatomic structures (arteries, pleura, nerves) - Be careful!

Question 3

What are the features of the Internal Jugular Vein?

Answer 3

Internal Jugular Vein;
- Located between the clavicular and sternal heads of the sternocleidomastoid
- Ultrasound-guided approach (nice 2002)
- Assess both right and left internal jugular veins

Right internal jugular vein;
- Better access to superior vena cava
- Avoids accidental injury to left thoracic duct
(See image)

Question 4

How would you find the Right Internal Jugular Vein on an ultrasound?

Answer 4

Next to Common Carotid artery (and common carotid by being below thyroid)

Question 5

What are the features of Ultrasound-guided Access?

Answer 5

• Real time needle tracking
• Maintain needle visualisation

Decrease mechanical complications;
- Arterial puncture
- Pneumothorax

Plane Approaches;
- Longitudinal (in-plane)
- Transverse (out-of-plane)
(see image)

Question 6

Where is the mastoid process?

Answer 6

The mastoid process is a smooth conical projection of bone located at the base of the mastoid area of the temporal bone. It allows the attachment of muscles such as the occipitofrontalis muscle, as well as certain muscles of the neck like the sternocleidmastoid and splenius capitis muscles.

Just behind ear