Best use for a bougie?

Much to our disgust EMCrit beat us to this one, hands down. But, given that the bougie is my favourite piece of kit and best buddy in the resus room, I’ve gone ahead and reposted these videos on LITFL.

They MUST be watched by all who perform (or assist with) emergency intubations.

The first video by John McGill, from HQMEDED, has already featured on Own the Airway!:

But the new video takes bougie trouble shooting to a whole new dimension of sophistication:

There are some great comments on the EMCrit blogpost, and I’ve reproduced a couple here that echo my own thoughts (or vice versa) on the bougie.

First up, Scott W himself:

…if you are going to intubate during compressions, the bougie makes things infinitely easier. Smaller cross section to fit through the moving target.

Bill Hinkley (who I believe is President-Elect of the Air Medical Physician Association):

$6 of pure blue plastic awesomeness. Also useful in place of a laser pointer when lecturing, and for smacking the hand of an overeager trauma surgeon who begins unnecessarily prepping the neck while you’ve got the airway management under control. Relax, my trauma friends, I’m joking. And speaking of crics, I won’t get into the whole needle v knife debate, but if you’re using a knife, using a bougie with it I believe is standard of care in 2012.” “Back to bougie as an aid to laryngoscopy… one other tip for easier tube passage over the bougie: once the bougie’s in the trachea, as the airway manager begins to advance the ETT over the bougie, the assistant should “walk their hands down the bougie” continuously as the ETT is advanced, thereby increasingly stabilizing the bougie closer and closer to the patient’s mouth. I’ve found that doing this allows the bougie to be a much more stable platform over which to railroad the tube, which makes tube passage past the larynx quite a bit easier.

… and, finally, Seth Trueger, who you’ll remember from Awake Intubation in Audio:

A few points: our disposable bougies are often stored with a slight curve, that is frequently in a different axis than the coude tip, which can lead to big problems during placement. You should check the tip each time. I liked his 60 degree curve for difficult airways– looks like a Gliderite stylet! I find that bending the bougie into a circle for a second (about the size of a central line wire) works well, especially in the patient with cspine precautions. (of course, make sure the axis of the circle and the coude tip are aligned). Lastly, he didn’t mention Levitan’s best points about the bougie: if you come in from the side, rotating the bougie gives you control in the vertical axis. Also, coming in from the side helps you ensure the tip comes in above the posterior structures. And always remember, the bougie is your best friend!

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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