Boujie Use/Info

[Fireguy273]

I currently am requesting that my medical control area approve the use of the Boujie for field EMS. It is used currently by the ER/OR in our hospitals and also by Flight Nurse/Medics. I have been asked by the Med Control Representative if there are any Field EMS Agencies that are using this device...Please give input!?! And if you can, link me to your protocols for this.

[p3medic]

Well I would just skirt the issue altogether and call it a "stylet" which it is. We carry them, don't have a particular protocol for their use. I use them frequently and for about $7.00 they are worth every penny.

[akflightmedic]

Agree with P3, why would you need a protocol for its use??

Just purchase them, train on them and use them.

Ask your legal and budgeting departments to collaborate...7 bucks versus possibly multiple failed attempts at securing a airway resulting in undesirable end result.

[Fireguy273]

I wasn't sure if we needed the "approval" so I went to our medical control office and talked to them-they said they would ask our medical director and get his ok to use it... and have so far been initially denied - which as you say, doesn't make much sense why we would need approval since we would still be within our scope of practice. Ya wouldn't expect we would need an ok to use a Glide Scope right? Just another tool in the airway tool box is my opinion.

[Doczilla]

Several EMS agencies in our area use them. There is no specific "protocol" for their use, which is left to the paramedic's discretion, just as there is no protocol which states which laryngoscope blade to use. Our tactical medics have them also for digital intubation use.

I just read an interesting article in the Journal of Special Operations Medicine last night, which detailed use of the bougie to intubate in a retrograde fashion through a surgical cricothyroidotomy (night vision goggles optional). It's ike a retrograde wireguided intubation, but through an incision rather than a needle. Considering how difficult a wire is to see in the back of the airway (particularly a bloody one), this might be a little easier to see. I thought it might be a useful skill to add to the medic's toolbox.

'zilla

[spenac]

Bougie is a stylet. It is also easy to use.

[p3medic]

Several EMS agencies in our area use them. There is no specific "protocol" for their use, which is left to the paramedic's discretion, just as there is no protocol which states which laryngoscope blade to use. Our tactical medics have them also for digital intubation use.

I just read an interesting article in the Journal of Special Operations Medicine last night, which detailed use of the bougie to intubate in a retrograde fashion through a surgical cricothyroidotomy (night vision goggles optional). It's ike a retrograde wireguided intubation, but through an incision rather than a needle. Considering how difficult a wire is to see in the back of the airway (particularly a bloody one), this might be a little easier to see. I thought it might be a useful skill to add to the medic's toolbox.

'zilla

It seems as if you are going to make the incision to pass a bougie you might as well just do the cric and canulate the trachea, no? I can see it working, and its definately bigger than the guidewire, but at least you can pass the wire through a needle, you know what I mean?

[Arctickat]

Why not get one of these?

http://www.res-q-tech-na.com/

or this

http://www.intubate123.com/newtest2/3pgr.pdf

or this

http://baobabmedical.com.au/portablecolourvideo.html

even this

http://www.cja-jca.org/cgi/content/full/51/6/642

Okay, I'll stop now.

[Doczilla]

You know, I misspoke, and after rereading the article, see what they are getting at and why. The article in JSOM indicates placement of the bougie anterograde through the incision and into the R mainstem bronchus, not retrograde as I initially indicated. The advantages of the procedure as indicated in the article are this: no need for a hook or dilator, lateral displacement of the membrane, which allows for a larger endotracheal tube than 6mm, and lateral displacement of the membrane reducing the chance of vessel injury or rescuer injury from the blade as you spread the incision. My apologies for any resulting confusion.

It seems as if you are going to make the incision to pass a bougie you might as well just do the cric and canulate the trachea, no? I can see it working, and its definately bigger than the guidewire, but at least you can pass the wire through a needle, you know what I mean?

Surgical cric is a temporizing measure, and has to be converted to another form of secure airway soon after arrival at the hospital (either tracheostomy or placement of an oral endotracheal tube under more controlled conditions.) The incision needed for bougie retrograde intubation is also much smaller than that required for a cric, so less danger of running into vessels you don't want to run into.

Why not get one of these?

http://www.res-q-tech-na.com/

Nice idea. Airtraq is probably cheaper, more compact, and works on the same principle.

http://www.intubate123.com/newtest2/3pgr.pdf

Similar idea to the Glidescope. Also not cheap, I'm sure.

http://baobabmedical.com.au/portablecolourvideo.html

Same thing as above. Could this be the manufactured version of the patent shown above?

http://www.cja-jca.org/cgi/content/full/51/6/642

Homemade Glidescope Ranger, which is currently available for purchase in the US at the bargain price of $8900.

I'm a fan of the Glidescope and the Airtraq (I have no financial interest in either), and would recommend them for any agency that can afford to purchase them. The Glidescope is prohibitively expensive for many agencies, particularly with multiple trucks, but the Airtraq runs about $80, so it's a cheap piece of insurance.

'zilla

[Fireguy273]

Some seem to be confused about the use of the bougie - it is not a surgical proceedure. It is like someone else mentioned a stylet type device placed into the airway via the same method as the ET tube when you are not able to visualize the vocal cords - a guide if you will to get the tube slide over it and into the correct location.

I am looking at many options to add to the "tool box" but also as someone mentioned there are financial concerns with some of the equipment suggested and the boujie is cheap as well as highly recommended by Flight Nurses/Paramedics I know that use them. I am just trying to get my Medical Director to approve of their use.

I am unsure why it is necessary for his approval since as someone stated - it is just a stylet - Use it as such. So far.... But I am still trying to lobby for it.