Reuben Strayer is back with more procedural pearls. This time, it’s all about the bougie. Reuben recommends using the bougie for every intubation, not just the hard ones.
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YES! There's a reason many of our SF medics have been required to use a bougie for every field intubation - cause they are a great tool!
And definitely +1 on the bougie assisted crich. I got to revise my practice of ordering an adult diaper with the crich tray after incorporating these into my surgical practice.
Seems the Europeans have more to offer than men's speedos
I've been using a bougie for every intubation except the most glaring open accessible vocal cord view since 2002 or so. Have done over 2000 intubations in that time and have failed 5 times. I have done them on first pass with absolutely no view of even the tip of the epiglottis by shaping the bougie, identifying the larynx and having someone put there hand on that area in order to give me a target, and then running the bougie along the post surface of the Mac blade more times than I can count. It's simply a great tool IMO.
In full agreement that bougies are essential in our armamentarium of airway devices and the significant role they play as an adjunct to VL (in particular the Glidescope d/t the acutely angled blade). Surprised to hear there was little discussion of potential complications here. There have been rare but well reported devastating/fatal adverse events with bougies including airway trauma and bleeding, avulsion of segmental bronchus and unilateral/bilateral tension ptx. One such event occurred recently at our institution. These events may be more likely when a bougie is "forced" in the heat of a moment. I feel the suggestion to find the tactile feedback of the carina should also be accompanied by significant caution -it is rarely necessary to advance a bougie this far and puts the patient at further risk of airway trauma. Thanks for the segment and discussion.
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Alexander M. - February 21, 2016 11:27 AM
YES! There's a reason many of our SF medics have been required to use a bougie for every field intubation - cause they are a great tool!
And definitely +1 on the bougie assisted crich. I got to revise my practice of ordering an adult diaper with the crich tray after incorporating these into my surgical practice.
Seems the Europeans have more to offer than men's speedos
Kevin M. - March 7, 2016 11:24 AM
I've been using a bougie for every intubation except the most glaring open accessible vocal cord view since 2002 or so. Have done over 2000 intubations in that time and have failed 5 times. I have done them on first pass with absolutely no view of even the tip of the epiglottis by shaping the bougie, identifying the larynx and having someone put there hand on that area in order to give me a target, and then running the bougie along the post surface of the Mac blade more times than I can count. It's simply a great tool IMO.
Joseph B. - May 21, 2016 12:35 PM
In full agreement that bougies are essential in our armamentarium of airway devices and the significant role they play as an adjunct to VL (in particular the Glidescope d/t the acutely angled blade). Surprised to hear there was little discussion of potential complications here. There have been rare but well reported devastating/fatal adverse events with bougies including airway trauma and bleeding, avulsion of segmental bronchus and unilateral/bilateral tension ptx. One such event occurred recently at our institution. These events may be more likely when a bougie is "forced" in the heat of a moment. I feel the suggestion to find the tactile feedback of the carina should also be accompanied by significant caution -it is rarely necessary to advance a bougie this far and puts the patient at further risk of airway trauma. Thanks for the segment and discussion.