Bougie Intubations

[VentMedic]

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?

Bougies are cheaper, quick and the patient can get connected to the ventilator with ETI. An LMA should not be connected to a ventilator.

Minor surgical procedures can be done with an LMA but that is a very different concept and closer observation again where the anesth. doctor, CRNA or RRT is at the patient's head the whole time.

[spenac]

Do any of you already have the tube over the bougie in order to avoid the complaints some list? In other words using it like any other stylet other than the end is past end of tube.

[Arizonaffcep]

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.

Do a search on Dr. John C. Sakles out of UMC...he's one of our ED docs and is currently doing research on difficult airways and intubations in the ED. Also, in conjunction with him, www.theairwaysite.com is a good resource.

[VentMedic]

Do a search on Dr. John C. Sakles out of UMC...he's one of our ED docs and is currently doing research on difficult airways and intubations in the ED. Also, in conjunction with him, www.theairwaysite.com is a good resource.

I believe in the past he has contacted the hospital physicians I work with since we are known for using fiber optic scope and video assisted intubation. We often record damage from traumatic intubations or other difficult intubations for teaching purposes and whatever legalities might arise later.

[paramedicmike]

Do any of you already have the tube over the bougie in order to avoid the complaints some list? In other words using it like any other stylet other than the end is past end of tube.

Yes, Spen. As AZCEP noted above, I anticipate a difficult airway on any prehospital tube I place. I don't know if it will present as a difficult airway until I look (I may suspect one way or another but have been surprised either way much too often).

So, when I go to place a tube, I will have the bougie ready with a tube loaded. During visualization, if it turns out I didn't need it then oh well. It just means I have good practice for all those times when I *DO* need it. But if it turns out I do need it, then I don't have to withdraw the laryngoscope, grab the bougie, load the tube and try again all of which delays getting that patient's airway secure and can cause extra trauma to the patient's airway.

-be safe

[AnthonyM83]

Since we're on the topic, anyone know what might be found in "Difficult Intubation Kit"? They called for it in the ER the other day...someone had to go to some special supply room to get. Only some of the ER staff even knew they had one, so not even used for most difficult intubations... I know LMA was in it which I think he used in some creative manner to get the ET tube in...

[akroeze]

Since we're on the topic, anyone know what might be found in "Difficult Intubation Kit"? They called for it in the ER the other day...someone had to go to some special supply room to get. Only some of the ER staff even knew they had one, so not even used for most difficult intubations... I know LMA was in it which I think he used in some creative manner to get the ET tube in...

Google Intubating LMA.... they're pretty cool.

[AZCEP]

Yep, the LMA FastTrach is pretty slick. As for the "Difficult Airway" set, it is probably a box full of equipment that no one ever thinks about getting until they trip over it, or need to use it as a step stool.

www.theairwaysite.com has some recommendations as to what should be included in one, if you are interested. It really doesn't have anything that you shouldn't have readily at hand, EMS wise though.

[Arizonaffcep]

Since we're on the topic, anyone know what might be found in "Difficult Intubation Kit"? They called for it in the ER the other day...someone had to go to some special supply room to get. Only some of the ER staff even knew they had one, so not even used for most difficult intubations... I know LMA was in it which I think he used in some creative manner to get the ET tube in...

Our "Difficult Airway Cart" contains: various sizes of the AirTraq, Bougies, Tube Exchangers, disposable blades for one of the Glidescopes, additional reusable blades for the other, a DL kit, Combi Tubes, 2 double Cric Kits, 1 surgical and the other a Seldinger (the two are in a single kit, we have 2 kits), Trachlights, and a variety of Intubating LMA's and standard LMA's. Also available (when Dr. Sakles is working) is a Glidescope Ranger, Pentax Airway Scope, and several other things I'm sure I'm forgetting.

[ukcanuck]

Hi there just came across this thread today but wanted to add that bougies have been used here in my service in the UK for several years.

We believe in optimising first time attempt and so recommend you use one on every tube. Adult down to ped's - and they make ped tubes A LOT easier IMHO.

If you don't it is up to you but most do use bougies on every tube.

Personally I set up with a bougie and if I get a grade 1 then pass the tube but anything less gets a bougie then tube.

It is not about showing whether the paramedic can intubate w/o adjuncts but rather actually doing it first time for the patient.

We are also looking at disposable McCoy blades with the little flipping tip which makes a difference to the grade of view. We use them on the critical care team I have association with and the flight system I am part of. We set up with the McCoy on, bougie ready to pass once view is achieved, and the rest of kit for tubing and LMA out ready in case of failure.

Plan to fail and you never will.

If you have the ability to sway your service to using them then do. It should make a big difference to your first time success rate - that sounds like a study to do foe someone

I will try to dig out some research we used when we started recommending this method and post it.