Bougie Intubations

[fireflymedic]

For those of you that utilize bougies for intubation - how does it improve your intubation success rate overall for pts that may have had to have an alternative airway otherwise (ie king, combi, lma)? I'm specifically looking for information relating to difficult intubations such as bull necked patients or extreme obese as those are the ones commonly encountered. Thanks for the info.

[Ridryder 911]

One of the larger EMS in my area has been using the "elastic bougie" or common one in EMS is the flex guide and has increased their intubation rate from 93% to 99%. I personally have used them on two very anterior anatomical intubations and recommend them for difficult intubations. I highly recommend them!

They are disposable, easy to learn to use, and economical. Better to have and be able to grab than not to.

R/r 911

[p3medic]

Intubated a guy yesterday with one, 50yo male, c-spine immobilized w/grade 3 view on laryngoscopy, placed a bougie and introduced a #8.0ett on first attempt.....big fan!

[VentMedic]

In the hospital setting I don't use alternative airways such as LMAs or Combitubes if the patient is going on a ventilator. I am not hand bagging a patient for 12 hours. I will use a bougie if it is a difficult intubation. I also have other devices that I can use but the bougie is quick and can be easily carried on transport.

[tniuqs]

One of the larger EMS in my area has been using the "elastic bougie" or common one in EMS is the flex guide and has increased their intubation rate from 93% to 99%. I personally have used them on two very anterior anatomical intubations and recommend them for difficult intubations. I highly recommend them!

They are disposable, easy to learn to use, and economical. Better to have and be able to grab than not to.

R/r 911

Rid: Do you have the study ? I would be in your debt if I could prove that the bougie is the airway adjunt of choice.

I have (not personally used) but did observe a boogie used in a serious facial smash as a retrograde introducer, it worked slick !

I too must agree with all the other Posts, this 10 dollar item IS the way to GO.

cheers

[Ridryder 911]

It was not a study more than a QI improvement drastically noted after the introduction and usage. I will try to obtain that though. As well, there are tons of literature on the use of such devices, especially in the O.R.

R/r 911

[JakeEMTP]

I am taking an advanced airway class this upcoming wknd. I hope they introduce us to this.

[tniuqs]

It was not a study more than a QI improvement drastically noted after the introduction and usage. I will try to obtain that though. As well, there are tons of literature on the use of such devices, especially in the O.R.

R/r 911

Thanks R/r, I think a big point in there is the move away from Paramedic doing ETT in the field, the fall out from US studies is affecting opinion here ... WE JUST HAVE to do do more Field studies to validate ALS with the flawed OPALs studies comming out of Ontario, heck even Dr Westly quoted them in JEMS ... may god help him.

lol

[PhillyD]

The definition of Bougie: “A thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to diagnose or treat a condition. A bougie may be used to widen a passageway, guide another instrument into a passageway, or dislodge an object.” One of the most common uses of the term in medicine refers to a weighted esophageal dilator.

Introducer is probably a more accurate description. You put the narrow bougie (introducer) in first when confronted with a difficult intubation, and then send the ET tube down over the long stylet. An even better technique is to pre-load the introducer in the ET tube, holding them together in your right hand. That way you are not fumbling when trying to hold the introducer while feeding the tube down over the top.

Another name this type device can go by is ET Tube Changer. RT's have been using these for years to permit changing an old tube, or one with a bad cuff for a new one, without needing to perform laryngoscopy. You just slide down the "changer", and pull out the old tube while leaving the changer in position. Then you slide the new one on to the previously noted depth. But the length and diameter of these tube changers and introducer's and bougies are all nearly the same. So by whatever name, for our practical purposes in EMS they remain the same.

The first time I saw one about ten years ago, it was in the back pocket of an anesthesiologist at Shock Trauma in Baltimore. When I asked what it was he explained it and shared that he had not performed a surgical airway since starting to use it. That really got my attention, and after trying it once I was hooked.

The nice thing about this device is the ease of learning & skill retention. The problem with many alternate airway techniques is that they are very different from your normal intubation technique.With a bougie, you are still using the same basic technique as normal. Scope in left hand, tube in right, passed under direct visualization. That makes it easier to learn and retain the skill, even when used infrequently.There are several different bougies available.

My favorites are the #JEM370 from Instrumentation Industries, and the SunMed #9-0212-70. Either is stiff enough to enhance control. One of the two available SunMed models has a “bent” or coude tip, which allows you to feel the movement of the stylet tip against the tracheal rings during insertion. This is the least expensive alternate or backup airway adjunct on the market. It can help you secure a definitive airway under the toughest field conditions. These devices are less than 10 bucks each. Bang for the buck wise, this is a great value for what it can do in a pinch.

[reaper]

We carried them at my last service. They are very nice to have for difficult airways.

As Philly mentioned, The one we carried had a bend at the end. You curve it and insert it. Then you feel for the bumping against the cartilage rings. Once you are in, you slide the tube over it and pull the Bougie out.

They are cheap enough, that they should be carried on every ALS truck.