How Do You Intubate While Ventilating?

[sladey67]

Chill out, sladey.

Hey I'm chilled.

Your original post did not refer to an intubating LMA. The impression I got was you were using a stock LMA, sliding a bougie down and presto you were in!

I was simply trying to say (in my own weird way) that this seemed very idealistic and simplistic and not realistic.

Thank you for the info ... I'll have a read when I have a little down time.

[fiznat]

Hey no big deal. I misunderstood your tone as well.

[Spock]

Using the bougie in any manner is still a blind technique and does not work 100% of the time. And you can cause significant damage to the trachea if you advance it to far. Any resistance is bad. I've seen considerable blood come out of the tube when the bougie went in to far. 30 cm is far enough because that is the distance of a normal endotracheal tube.

When I have to change a tube I will place a bougie (tube changer) down the existing tube and then do a laryngoscopy. If I can see the tube passing through the cords I will have somebody else pull the existing tube while leaving the bougie in place. Then I will place the larger tube around the bougie, confirm placement and then remove the bougie. We have to do this frequently when medics bring in burn patients and they placed a small tube initially. Long term ventilation becomes a problem with a small tube. I addressed this issue in a previous post.

Live long and prosper.

Spock

[ccmedoc]

Although the bougie is a blind technique, oft times the laryngoscope is still used to displace some soft tissue and the tongue, so you can at least visualize the epiglottis. If the bougie is in the trachea, by withdrawing it slightly, you would feel a vibration, or "tracheal click". This is the end of the introducer against the tracheal rings. After the ET tube placement, confirmation should be made of course. An attempt at visualizing the tube placement is not unwarranted or ill advised..This is a slick unit, but can be cost prohibitive, or used to be until what is called the "blue bougie" has come out..this is disposable and relatively low cost. The arguments against use of this device in EMS systems is the deterioration of intubation skills of medics due to relying too heavily on the product and not attempting to visualize cords initially. I'm not sure I agree with this.

-steve

[AZCEP]

I have to disagree with you, Spock.

You can use the bougie, or flexible endotracheal tube introducer, under direct visualization. Placing it into the trachea prior to inserting an ET tube is the most common method that I've seen. We also pre-assemble the tube onto the introducer to speed things up a bit.

Yes, it can result in a traumatic intubation if improperly used. At the 30 cm depth you mention, the coude tip should get hung up at/near the carina and not allow further advancement.

[Spock]

I'm not sure we are really disagreeing here but may just be splitting hairs. If you can see the trachea under direct visualization why bother with a bougie--just put the tube in. If you can't see the cords you can pass the bougie blindly into the trachea and then pass the endo tube over the bougie. I used a bougie the other day to replace a trach.

Live long and prosper.

Spock

[AZCEP]

I use the bougie on all intubations so that I'm prepared in advance for the difficult presentation. This way, I don't have to remove the laryngoscope, reventilate before reattempting.

[Dustdevil]

Go big or go home. That's why I trach all of my apneic patients. Higher first-time success rate. No broken teeth. Fewer gadgets to mess with. And no batteries to replace.

[BushyFromOz]

Go big or go home. That's why I trach all of my apneic patients. Higher first-time success rate. No broken teeth. Fewer gadgets to mess with. And no batteries to replace.

And for that truely open airway, decapitation is also an option that is totally underused

[als_medic_uk]

Ventilation is maintained throughout the intubation sequence by means of using a cuffed oropharyngeal airway.

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