Bougie Intubations

[sevenball]

My service just introduced the bougie, or BAM stick to our medics. I've had extensive training on these, and it is my understanding that in clinical trials, the bougie had a 99.9% sucess rate when used in accordance with the manufacturer. As my education coordinator plainly states "We should be able to secure an ETT every time we attempt one, there is no reason we should ever fail to introduce a secure and definative airway. If that means coming up with 10 different ways to tube, so be it."

That being said, it is my impression that if we utilize the bougie after a failed attempt, then there would be no reason to resort to a secondary means of securing an airway, ever!

[JPINFV]

Serious question time.

If the bougie is so great and all, why not use it for all intubations and not just ones where direct visualization has failed? Am I missing something (most likely), or is it a case of tradition?

[spenac]

Serious question time.

If the bougie is so great and all, why not use it for all intubations and not just ones where direct visualization has failed? Am I missing something (most likely), or is it a case of tradition?

I actually know some that use them rather than a stylet on all intubations. Why not they are not expensive?

[ERDoc]

Serious question time.

If the bougie is so great and all, why not use it for all intubations and not just ones where direct visualization has failed? Am I missing something (most likely), or is it a case of tradition?

I think it has more to do with the KISS principle. Why use more equipment than you need to if you can do the job with less. If I can cleaerly see the cords, why would I want to put something else in the way that may obstruct my view? The most important factor in intubation is positioning. The pt should always be in the sniffing position, assuming you don't have to worry about c-spine. I have found that a large percent of providers (both hospital and prehospital) don't actually know what the sniffing position is.

Another nice option is the GlideScope, but I can't see too many companies shelling out the big bucks for this nice little toy. I've used it a few times on manequins and have been quite impressed.

[p3medic]

We fielded the Glidescope for a trial, loved the view, but passing the tube was a bit different, there is no displacement of the airway anatomy w/the glidescope, so it was a bit different. As for using a bougie on every attempt, I don't. It is quicker to just use a tube and stylet, the bougie takes a few seconds longer, at least when I do it. I grab a bougie for an anticipated difficult tube, i.e. short neck, c-spine, etc...

[AZCEP]

That's pretty reasonable P3, but my take is a bit different.

I anticipate every prehospital airway to be difficult, and use the bougie for each attempt. The cases you list are good times to have alternatives ready, but if you can use a bougie to prevent needing one after looking why not?

To each their own.

[toutdoors]

One of the docs that supervised me while doing my intubations in the OR clinicals was a huge fan of the bougie. She made everyone of her students do at least one intubation with it. I loved it. I wish we carried them on or rigs. It would make sense. It is simple, easy, efficient, and ALMOST ensures you will get the tube. She was my favorite to work with also, very relaxed, gave me confidence I had no idea I had in regards to intubating, and was very positive. Every time she was with me, I got the tube. Now the other doc, I don't know what it was about him, but I just did not have good success with him being there to precept me. Must have been a vibe thing or something, he wasn't a jerk per se, it was just that something was "off" if he was the one with me that day.

Anyway, I am a huge fan of the bougie. Now if we could come up with one that would do the same for IV's. This has got to be my worst week ever with the exception of my first few months as an EMT-I for hitting a darn IV. Must be cause I haven't arrowed a buck yet this season, who knows. If you have not tried the bougie, try it. If you can get them on your rigs, do it. I am trying to wear down our decsion makers into getting them.

[celticcare]

We covered the use of the bougie in my ACLS course in September for work *CCU RN*. We carry one on each resus trolley in CCU and when practicing on the manikins *and yes before you old farts in here who have to have your two cents worth, I know a manikin is different from a patient blah bloody blah* the bougie made intubation ten times easier than the laryngascope and tube on its own. I have to go with P3 though, if you can see the cords, why double handle, shove the tube in, inflate and away you go. if its going to be a difficult one, then get the bougie but if you can see it, then shove it in.

To quote the great Uncy Lone "Any holes a goal".

Scotty

[VentMedic]

I believe in using anything that will make the endotracheal intubation less traumatic. Few realize that if one has a very difficult time with the intubation by repeated attempts, the patient's stay on the ventilator may extend from what should have been a few hours or a day to a couple of weeks and may even a trach. There's probably a paper waiting to be written from some of our data concerning failed leak tests that prolong intubation. Often in the ED, the whole story about the difficult intubation is not presented usually due to egos.

[Arizonaffcep]

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.

I assume they would want an LMA on a patient who isn't going to be intubated for any real length of time, otherwise, why not use an intubating LMA and intubate them?