Bimanual laryngoscopy

[12R34Y]

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there was a huge article on bimanual technique versus uni-manual 😀 intubation success in the annals of emergency medicine this month.

Just one question..........the BURP technique is used on the thyroid cartilage? is this correct.

I was just taught incorrectly as a paramedic years ago by one of our education guys that told us to do BURP with cricoid.

So, does doing the BURP technique also have the same benefit of having cricoid pressure (ie no regurg).

Or do you need another person........one holding cricoid and the intubator doing BURP?

thanks guys.

later

 

[Noyac]

Burp?

 

[jwk]

Burp?

Consider the source - Annals of Emergency Medicine

 

[Monty Python]

Burp?

A certain method of giving cricoid pressure to bring the cords into view: Backward Upward Rightward Pressure

 

[Noyac]

A certain method of giving cricoid pressure to bring the cords into view: Backward Upward Rightward Pressure

Ok, now what the hell is "backward upward rightward pressure?" With that much manipulation I'm surprised they don't pull the cords right out of the throat. 😱

 

[Monty Python]

Ok, now what the hell is "backward upward rightward pressure?" With that much manipulation I'm surprised they don't pull the cords right out of the throat. 😱

Imagine you're the person giving BURP. Supposedly if you push the thyroid and cricoid cartilages backward (posteriorly) upward (cranially) and to the right it will aid bringing the cords into view, when someone is performing laryngoscopy from the right side of the mouth and sweeping towards the midline.


Anesth Analg. 1997 Feb;84(2):419-21 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9024040&dopt=Abstract

The displacement of the larynx in the three specific directions (a) posteriorly against the cervical vertebrae, (b) superiorly as possible, and (c) slightly laterally to the right have been reported and named the "BURP" maneuver. We concluded that the BURP maneuver improved the visualization of the larynx more easily than simple back pressure on the larynx

A different viewpoint: http://www.cja-jca.org/cgi/content/full/52/1/100

Benumof has his own opinion: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=8695096&dopt=Abstract

Benumof JL, Cooper SD. Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. J Clin Anesth 1996; 8: 136–

 

[12R34Y]

Consider the source - Annals of Emergency Medicine

Funny, how I found mention of BURP in anesthesia journals.

I guess I don't get your comment. Or could it be that you just don't know EVERYTHING about anesthesia?

thought i could ask a legit question as a incoming EM intern (longtime medic) and get a congenial response........instead I get an AA with sarcasm. 👎

 

[jwk]

Funny, how I found mention of BURP in anesthesia journals.

I guess I don't get your comment. Or could it be that you just don't know EVERYTHING about anesthesia?

thought i could ask a legit question as a incoming EM intern (longtime medic) and get a congenial response........instead I get an AA with sarcasm. 👎

Well, I've only been doing anesthesia 27 years, and just for good measure, a paramedic for three years before that, so I admit I'm just an amateur. Manipulating the airway for a better view is just kind of the natural thing to do - who knew someone would go and write an article about it and give it a cute little name.

BTW, your original post mentioned an EM journal, not anesthesia. Trin provided the literature cites.

And I'll be the first to admit I don't know everything about anesthesia, but I have yet to learn any airway tricks from the ER side of the hospital. When they're in a tight they call us - never the other way around.

 

[12R34Y]

And I'll be the first to admit I don't know everything about anesthesia.

I concur. Maybe 27 more years and you'll start to get the hang of it.

BURP isn't a cute name either.

later

 

[DrDre']

JWK,

I have always respected your posts but these last few took you down many notches. Come on. The arrogance in your posts and the disrespect for an interesting question that lead to a good discussion... Why taint it with your issues? You sound like a paragod!

I concur. Maybe 27 more years and you'll start to get the hang of it.

BURP isn't a cute name either.

later

 

[DrDre']

JWK,
I have always found your posts informative and politically very balanced. Until this post. 12 asked a reasonable question, showing respect for our field and knowledge base. You have to turn it into an insult to EM. Why? You know your arrogance really comes out on those posts. You sound like a paragod! For someone who is at least 30, assuming you started as a paramedic when you were born, it shows tons of maturity.

I concur. Maybe 27 more years and you'll start to get the hang of it.

BURP isn't a cute name either.

later

 

[DrDre']

12R34Y, Former EMSLRCer if you remember, forgot where you matched?

Good luck with the following years.

JWK,
I have always found your posts informative and politically very balanced. Until this post. 12 asked a reasonable question, showing respect for our field and knowledge base. You have to turn it into an insult to EM. Why? You know your arrogance really comes out on those posts. You sound like a paragod! For someone who is at least 30, assuming you started as a paramedic when you were born, it shows tons of maturity.

 

[DrDre']

Sorry all for the double post re: JWK, thought i lost the first one.

Anyone care to answer one of the original questions of the op?

I would assume that BURP backs you up against regurgitation as much as Sellicks? Any takers before I read all the articles.

12R34Y, Former EMSLRCer if you remember, forgot where you matched?

Good luck with the following years.

 

[jwk]

JWK,
I have always found your posts informative and politically very balanced. Until this post. 12 asked a reasonable question, showing respect for our field and knowledge base. You have to turn it into an insult to EM. Why? You know your arrogance really comes out on those posts. You sound like a paragod! For someone who is at least 30, assuming you started as a paramedic when you were born, it shows tons of maturity.

The dig at the EM journal comes from the same part of me that would complain about GI docs/journals talking about how wonderfully safe propofol is in their hands as opposed to an anesthesia provider. It was meant as a joke in the anesthesiology forum and not intended as a slam at EM.

OK - the original question - as I stated already, who knew something that we already do every day would get a name and a study or three? Anway, I'm not sure just manipulating the thyroid cartilage gets you the same effect as cricoid pressure. The cricoid is a solid ring, and small enough that when you press on it, it can close off the esophagus. I doubt you'd get the same type of seal with the large, not as mobile, thyroid cartilage.

 

[bestiller]

The dig at the EM journal comes from the same part of me that would complain about GI docs/journals talking about how wonderfully safe propofol is in their hands as opposed to an anesthesia provider. It was meant as a joke in the anesthesiology forum and not intended as a slam at EM.

OK - the original question - as I stated already, who knew something that we already do every day would get a name and a study or three? Anway, I'm not sure just manipulating the thyroid cartilage gets you the same effect as cricoid pressure. The cricoid is a solid ring, and small enough that when you press on it, it can close off the esophagus. I doubt you'd get the same type of seal with the large, not as mobile, thyroid cartilage.

BURP? 😀

 

[VolatileAgent]

those whacky er docs trying to grab some glory and reinvent the wheel. we already have a name for this. it's called "sellick's maneuver". of course, most probably wouldn't know this because they don't get nearly the training in airway management that we do. but, cute little acronym's usually win the day, don't they?

 

[DrDre']

Thx JWK, Sorry to jump on you. BURP sounds different than Sellick's. To me, sellick's is straight posterior on cricoid. IF you did burp WITH the cricoid AND the thyroid maybe it would be as preventative and aid in the view more than Sellick's?


Academia is full of stupid papers! That's how they get raises.

those whacky er docs trying to grab some glory and reinvent the wheel. we already have a name for this. it's called "sellick's maneuver". of course, most probably wouldn't know this because they don't get nearly the training in airway management that we do. but, cute little acronym's usually win the day, don't they?

 

[12R34Y]

those whacky er docs trying to grab some glory and reinvent the wheel. we already have a name for this. it's called "sellick's maneuver". of course, most probably wouldn't know this because they don't get nearly the training in airway management that we do. but, cute little acronym's usually win the day, don't they?

BURP maneuver is NOT sellick's.......(I figured you might know that).

BURP involves manipulating the thryoid cartilage.

you'll get the hang of this airway stuff if you just hang on and stick with it. 👍

 

[12R34Y]

12R34Y, Former EMSLRCer if you remember, forgot where you matched?

Good luck with the following years.

DrDre,

I matched my number 1. county program in the midwest. can't wait to get started!

how 'bout you?

 

[VolatileAgent]

you'll get the hang of this airway stuff if you just hang on and stick with it. 👍

i assure you that, at this point in my career, i've "manipulated" far more airways - including difficult ones - than most ER attendings ever have even after years of being in practice. (i've even had er attendings ask me to intubate for them when i've happened to be in the er doing other things.)

this "BURP" stuff is just silliness. in my experience, most er docs are afraid of and/or just simply do not optimize their chances of a good view because they don't use the correct drugs to get the patient in an optimal intubation state. they just don't have that kind of training. we do. period.

 

[12R34Y]

i assure you that, at this point in my career, i've "manipulated" far more airways - including difficult ones - than most ER attendings ever have even after years of being in practice. (i've even had er attendings ask me to intubate for them when i've happened to be in the er doing other things.)

this "BURP" stuff is just silliness. in my experience, most er docs are afraid of and/or just simply do not optimize their chances of a good view because they don't use the correct drugs to get the patient in an optimal intubation state. they just don't have that kind of training. we do. period.

nice try on backpedalling by bashing EM docs. The fact that you didn't understand that Sellick's (cricoid pressure) is NOT the BURP technique tells me a lot about your (you i particular) "expertise" in the airway department.

sounds like you've just been lucky up till now.

keep studying.........you'll get the nomenclature eventually.

later

 

[12R34Y]

Big mistake apparently to post an airway question on an anesthesia forum.

Obviously, I had a legit question and wanted to hear from the airway experts. I DID NOT post this in the EM forum where I usually post.

This should show the respect I have for the expertise that anesthesia brings. It was a very legit question and i was really just curious.

However, I immediately got EM bashing......so i responded appropriately to the couple of *****s (who obviously aren't that compotent in the first place by their ignorance of the topic) on the board.

so, never mind the question its not worth the trouble.

my bad.

later

 

[mysophobe]

Insulting members of the anesthesiology forum probably isn't a good way to get an answer to your question. JMHO.

 

[12R34Y]

Insulting members of the anesthesiology forum probably isn't a good way to get an answer to your question. JMHO.

have you even read the post? i have only insulted members of the anesthesia forum in response to EM bashing that was totally unprovoked and didn't attempt to answer my question. what are you talking about?

 

[mysophobe]

have you even read the post? i have only insulted members of the anesthesia forum in response to EM bashing that was totally unprovoked and didn't attempt to answer my question. what are you talking about?

Think about it for a minute. Yes, a couple people bashed EM. So what? You didn't come here to promote your specialty, you came here for an answer. A few people might be nasty, but if you remain polite, chances are someone will see you are earnest in your efforts and respond out of pity/general kindness/whatever. When you insult a few members of the forum, the rest of the people will see you as an a-hole and won't care if you get your answer or not. It's all politics.

EDIT: Btw, I wasn't attempting to bash or insult you. I was just giving some advice--no ill will intended.

 

[VolatileAgent]

nice try on backpedalling by bashing EM docs. The fact that you didn't understand that Sellick's (cricoid pressure) is NOT the BURP technique tells me a lot about your (you i particular) "expertise" in the airway department.

sounds like you've just been lucky up till now.

keep studying.........you'll get the nomenclature eventually.

later

you're right. i do not know what the "BURP" technique is because it is a stupid, made-up acronym that means nothing to an anesthesiologist. this "nomeclature" is not now nor will it ever be part of my lexicon. sellick's is on the cricoid cartilage because it is a ring and won't compress. you go muddling around on the thyroid cartilage, you most likely will be successful in doing nothing more than obstructing the airway anyway.

now, if you really came here to seek advice, then don't worry about some cutesy, made-up acronym - "BURP" or whatever else someone who wants to publish a paper dreams up - and instead learn how to use a Fastrach. otherwise, if you can't handle the heat and choose instead only to continue to be a dick, i suggest that you just go back to the er forum. maybe there's a higher tolerance for sciolism over there.

and, last but not least, just remember who you're going to call to get the airway when your BURP technique fails you, junior.

 

[Cap'nOblivious]

you're right. i do not know what the "BURP" technique is because it is a stupid, made-up acronym that means nothing to an anesthesiologist. this "nomeclature" is not now nor will it ever be part of my lexicon. sellick's is on the cricoid cartilage because it is a ring and won't compress. you go muddling around on the thyroid cartilage, you most likely will be successful in doing nothing more than obstructing the airway anyway.

now, if you really came here to seek advice, then don't worry about some cutesy, made-up acronym - "BURP" or whatever else someone who wants to publish a paper dreams up - and instead learn how to use a Fastrach. otherwise, if you can't handle the heat and choose instead only to continue to be a dick, i suggest that you just go back to the er forum. maybe there's a higher tolerance for sciolism over there.

and, last but not least, just remember who you're going to call to get the airway when your BURP technique fails you, junior.

Sciolism? Maybe you meant the ER forum has a higher tolerance for socialism?

 

[mysophobe]

sciolism - n. A pretentious attitude of scholarship; superficial knowledgeability.

 

[Cap'nOblivious]

Thanks. Great word.

 

[mysophobe]

Agreed. 👍

 

[12R34Y]

you're right. i do not know what the "BURP" technique is because it is a stupid, made-up acronym that means nothing to an anesthesiologist. this "nomeclature" is not now nor will it ever be part of my lexicon. sellick's is on the cricoid cartilage because it is a ring and won't compress. you go muddling around on the thyroid cartilage, you most likely will be successful in doing nothing more than obstructing the airway anyway.

now, if you really came here to seek advice, then don't worry about some cutesy, made-up acronym - "BURP" or whatever else someone who wants to publish a paper dreams up - and instead learn how to use a Fastrach. otherwise, if you can't handle the heat and choose instead only to continue to be a dick, i suggest that you just go back to the er forum. maybe there's a higher tolerance for sciolism over there.

and, last but not least, just remember who you're going to call to get the airway when your BURP technique fails you, junior.

ooooooooooo.....i'm shaking now

plenty of anesthesia journals talk about manipulation of the thyroid cartilage to improve your view. type in a google search with BURP anesthesiology and the first 20 results are the BURP technique.

get over yourself junior

 

[jetproppilot]

ooooooooooo.....i'm shaking now

plenty of anesthesia journals talk about manipulation of the thyroid cartilage to improve your view. type in a google search with BURP anesthesiology and the first 20 results are the BURP technique.

get over yourself junior

I gotta go with 12Ryebb34Yry (grin) on this one.

I'd never heard of the Burp thing either until a CRNA from my previous practice went to a meeting and subsequently told me about it.

Screw all the technical s h it....cricoid vs thyroid etc...

pushing down on the larynx and shoving it to the right DOES enhance visualization during laryngoscopy. Think about it....a good view is achieved by having no tongue to the right of the blade....tongue swept to the left...larynx displaced to the RIGHT makes sense.

It works, no matter who invented it....ER doc, anesthesiologist, janitor, professional poker player...doesnt matter.

And we shouldnt take offense that it was published by an ER dude. Taking offense to this is just perpetuating the academic egocentrism that nobody cares about out here in the real world.

Its a good trick to have in your back pocket.

And I think the posters were a little harsh on the ER dude for no good reason.

I'm all for assassinating trolls. But this dude wasnt trolling.

 

[12R34Y]

I gotta go with 12Ryebb34Yry (grin) on this one.

I'd never heard of the Burp thing either until a CRNA from my previous practice went to a meeting and subsequently told me about it.

Screw all the technical s h it....cricoid vs thyroid etc...

pushing down on the larynx and shoving it to the right DOES enhance visualization during laryngoscopy. Think about it....a good view is achieved by having no tongue to the right of the blade....tongue swept to the left...larynx displaced to the RIGHT makes sense.

It works, no matter who invented it....ER doc, anesthesiologist, janitor, professional poker player...doesnt matter.

And we shouldnt take offense that it was published by an ER dude. Taking offense to this is just perpetuating the academic egocentrism that nobody cares about out here in the real world.

Its a good trick to have in your back pocket.

And I think the posters were a little harsh on the ER dude for no good reason.

I'm all for assassinating trolls. But this dude wasnt trolling.

thanks for your comments on laryngeal manipulation. I don't have a lot of experience with manipulating the larynx, but hopefully I'll get to try a few things in my anesthesia rotation this year.

thanks

 

[jetproppilot]

you're right. i do not know what the "BURP" technique is because it is a stupid, made-up acronym that means nothing to an anesthesiologist. this "nomeclature" is not now nor will it ever be part of my lexicon. sellick's is on the cricoid cartilage because it is a ring and won't compress. you go muddling around on the thyroid cartilage, you most likely will be successful in doing nothing more than obstructing the airway anyway.

now, if you really came here to seek advice, then don't worry about some cutesy, made-up acronym - "BURP" or whatever else someone who wants to publish a paper dreams up - and instead learn how to use a Fastrach. otherwise, if you can't handle the heat and choose instead only to continue to be a dick, i suggest that you just go back to the er forum. maybe there's a higher tolerance for sciolism over there.

and, last but not least, just remember who you're going to call to get the airway when your BURP technique fails you, junior.

Volatile,

I think you're post is an attempt to assassinate a dude that was not trolling.

Just my opinion.

Furthermore, anesthesia training is not the 'know all end all" of airway management.

My residency trained me well. But they fell short on some issues that I had to figure out for myself. Two big ones come to mind that were NEVER pointed out to me when I was a resident:

1) Manipulating the larynx with your right hand, moving it from side to side, while holding the blade with your left hand, frequently enables you to find the cords if you don't initially see them. Call it BURP, SHMURP, or whatever you want. It works.

2) BOUGIE utilization has brought my need for the scope during a difficult airway to almost zero. In other words, if you can't get the tube in you can ALMOST ALWAYS get a bougie in, then slide the tube over it. Notice I said almost always . Not always.

So the BOUGIE is a commodity that should be taught to residents. And if a program is not teaching their residents the value of it's utility they are falling short.

 

[Noyac]

Volatile,

I think you're post is an attempt to assassinate a dude that was not trolling.

Just my opinion.

Furthermore, anesthesia training is not the 'know all end all" of airway management.

My residency trained me well. But they fell short on some issues that I had to figure out for myself. Two big ones come to mind that were NEVER pointed out to me when I was a resident:

1) Manipulating the larynx with your right hand, moving it from side to side, while holding the blade with your left hand, frequently enables you to find the cords if you don't initially see them. Call it BURP, SHMURP, or whatever you want. It works.

2) BOUGIE utilization has brought my need for the scope during a difficult airway to almost zero. In other words, if you can't get the tube in you can ALMOST ALWAYS get a bougie in, then slide the tube over it. Notice I said almost always . Not always.

So the BOUGIE is a commodity that should be taught to residents. And if a program is not teaching their residents the value of it's utility they are falling short.

Right Jet, some deficiancies exist in residency. There are a lot folks out there that believe they are the **** when it comes to airway management just b/c they are an anesthesia person. Those guys will learn someday, one way or another, that there is always someone better at a given time and place.
Also, the bougie sits on the side of our anesthesia cart in every room and I still have never, thats right never, used it. Hell, I can't remember the last time I couldn't intubate someone anyway. I'm sure it will be tomorrow, now that I have said that though. At least I'll think about that bougie thats been decorating my cart all these years. 👍

 

[Noyac]

Oh, I just remembered a funny story that sort of fits here.
Our ER docs usually respond to codes in the hosp b/c thats the way things have been here. So my group gets here and takes over. We start responding to the codes and realize that some things are amiss. Not bad but just not the way we would run a code. So now there are 2 or more docs at the codes and things were getting confusing. The administration told us that the nurses are getting confused with all the people there (2 docs giving orders I guess can be confusing) so they would appreciate it if we didn't respond unless called directly and that ER can manage the airway without us (which they can). I said fine with me. Then one of the ER docs takes it upon himself to tell us that there isn't anyone he can't intubate. 😱 He goes on to say he just finished a difficult airway course so he didn't think they would ever need us. GREAT, we said. The next week there was a code and then a STAT ANESTHESIA call. My partner runs upstairs and this same ER dude is there sweating and struggling mightily with the airway. My partner says," Oh my bad, you guys don't need me, you have DR. I Can Intubate Anyone." "I'll see you later." ER dude says wait. I need help. Anesthesia dude grabs blade pushes some meds and intubates. Looks at the E#R dude and says you think you can handle it from here?
The next day, administration said they would appreciate it if we would respond to codes again. 😀

Please don't mis-interrpret this story. Its not a ER vs. Anesth story at all. Just a funny story.

 

[jetproppilot]

Right Jet, some deficiancies exist in residency. There are a lot folks out there that believe they are the **** when it comes to airway management just b/c they are an anesthesia person. Those guys will learn someday, one way or another, that there is always someone better at a given time and place.
Also, the bougie sits on the side of our anesthesia cart in every room and I still have never, thats right never, used it. Hell, I can't remember the last time I couldn't intubate someone anyway. I'm sure it will be tomorrow, now that I have said that though. At least I'll think about that bougie thats been decorating my cart all these years. 👍

Noy,

you know I'm your Homie.

That being said,

if you haven't needed the BOUGIE, congratulations.

But eventually, you will. Believe me.

OUT.

 

[Noyac]

Noy,

you know I'm your Homie.

That being said,

if you haven't needed the BOUGIE, congratulations.

But eventually, you will. Believe me.

OUT.

Yes, thats exactly what I am saying. I just never think of it b/c I was never taught to use it in residency. But thanks to you, if I need it in the next couple of days it will be fresh in my mind and I might think about it.

 

[jetproppilot]

Oh, I just remembered a funny story that sort of fits here.
Our ER docs usually respond to codes in the hosp b/c thats the way things have been here. So my group gets here and takes over. We start responding to the codes and realize that some things are amiss. Not bad but just not the way we would run a code. So now there are 2 or more docs at the codes and things were getting confusing. The administration told us that the nurses are getting confused with all the people there (2 docs giving orders I guess can be confusing) so they would appreciate it if we didn't respond unless called directly and that ER can manage the airway without us (which they can). I said fine with me. Then one of the ER docs takes it upon himself to tell us that there isn't anyone he can't intubate. 😱 He goes on to say he just finished a difficult airway course so he didn't think they would ever need us. GREAT, we said. The next week there was a code and then a STAT ANESTHESIA call. My partner runs upstairs and this same ER dude is there sweating and struggling mightily with the airway. My partner says," Oh my bad, you guys don't need me, you have DR. I Can Intubate Anyone." "I'll see you later." ER dude says wait. I need help. Anesthesia dude grabs blade pushes some meds and intubates. Looks at the E#R dude and says you think you can handle it from here?
The next day, administration said they would appreciate it if we would respond to codes again. 😀

Please don't mis-interrpret this story. Its not a ER vs. Anesth story at all. Just a funny story.

HAHAHAHAHAHHAHAHAHAHAHAHA

Here's Jet's take on this important rhetoric.

No matter what your training is, no matter what your specialty is,

YOU ARE NEVER BEYOND ASKING FOR HELP.

And if you've reached the level beyond asking for help,

YOU ARE A LITIGINOUS AND CLINICAL RISK, ENDANGERING THE MONETARY WELL BEING OF YOUR PRACTICE, AND MORE IMPORTANTLY, ENDANGERING THE LIVES OF PATIENTS.

I've been in the airway practice for ten years now.

Two of my partners have half the experience I have.

But ya know what?

If I'm backed into a corner airway wise,

I'm wise enough to call for help.

My "junior" partners can help me when the chips are down.

Anesthesia is better served with more professionals intervening on a problem, rather than relying on just one brain.

Hence my vote for the TEAM PLAYA anesthesia model.

 

[jetproppilot]

Yes, thats exactly what I am saying. I just never think of it b/c I was never taught to use it in residency. But thanks to you, if I need it in the next couple of days it will be fresh in my mind and I might think about it.

OK, PERIODIC TROLLS,

YA SEE THIS??

Noy, a rokstar, saying he's learned something from this DOT.COM.

As I have, with numerous on-line conversations with rokkstars around the country.

Slay it at will.

Bottom line is that clinicians practicing anesthesia on a day-to-day basis are of the non-academic milleau, willing and able to listen to others abroad.

And there-in lies the problem with academic anesthesia.

The Willingness To Listen To Clinicians In The Real World.

We do cases out here, day in and day out.

With minimal morbidity/mortality.

Yet academic dude , who personally has done NIL cases, publishes a paper endorsing the utilization of proton-pump-inhibitors on C sections......

then said paper becomes prophecy.....

WTF??????

Lets take charge of our specialty, colleagues.

NUMBER ONE:

1) Alotta the prophylactic stuff we do (reglan, nexium) hasn't shown to reduce morbidity/mortality. So we're administering extra s h it that hasnt been shown to be of benefit.

2) ARE YOU REALLY SERVING SOME PURPOSE BY WAITING ON AN NPO PATIENT WHEN THE CASE HAS TO BE DONE ANYWAY??

emergency case, has to be done, ate a Whopper an hour ago;

is said Whopper gonna be really digested well 6 hours from now, in light of the current (STRESSFUL) surgical situation?

I know the answer to this.

Do you?

And, knowing the answer to this, are you ready and willing to step up to the MIC with MICATIN???

 

[VolatileAgent]

isn't there a private forum out there for you guys (or something)?

the irony that this technique is called "BURP" is not missed on me, especially since this is the last thing you want the patient to do during direct layrngoscopy.

come on, dudes. this is bullsh*t made-up stuff. call a spade a spade.

 

[militarymd]

I gotta to go with Jet and Noy.

 

[canjosh]

those whacky er docs trying to grab some glory and reinvent the wheel. we already have a name for this. it's called "sellick's maneuver". of course, most probably wouldn't know this because they don't get nearly the training in airway management that we do. but, cute little acronym's usually win the day, don't they?

Funny...I learned Sellick's maneuver when I was 17 years old...in EMT-Basic school. I'm pretty sure the EM guys/gals have picked up on this BASIC airway skill at some point during their petty/half-educated careers... 🙄

 

[TheSandMan]

Funny...I learned Sellick's maneuver when I was 17 years old...in EMT-Basic school. I'm pretty sure the EM guys/gals have picked up on this BASIC airway skill at some point during their petty/half-educated careers... 🙄

Canjosh, aren't u an EMT. You picked a pretty odd career if you don't like working with EM docs.

 

[TIVA]

The BURP technique is a method for bringing the vocal cords into view. It consists of backwards (posteriorly), upwards (superiorly), rightwards pressure on the tracheal cartilage. Does it work? Yes. It'll help make a good view better and a poor view gooder (? never mind the grammar, just got out of a pump case on a 2 day old).

The sellick maneuver is a technique during rapid sequence induction/intubation to help prevent regurgitation of contents through the esophagus into the pharynx and then possibly into the trachea. It consists of straight down pressure on the cricoid ring. How much pressure? About 10 newtons. How much is 10 newtons? About the weight of a medium sized textbook. So if you can imagine a medium sized textbook sitting on your throat (like maybe a 2005 copy of Barash), that's how much pressure is necessary to close off the soft muscular esophagus against the stiff tracheal rings.

Does it work? I'm glad you asked. Apparently, opinions differ to it's effectiveness. Some have said that their patients regurgitated in spite of applying Sellick's maneuver. Maybe they applied it wrong. Or, maybe it doesn't work. A study in England last year showed that Sellick's maneuver was ineffective against regurgitation.

Not ony that, but this maneuver is contraindicated in someone who is actively wretching or if they have a foreign object in the larynx/pharynx/esophagus. And my experience has shown that when Sellick's maneuver is being applied, it often makes laryngoscopy difficult because it distorts the anatomy. Thus, I prefer not to have it done, even in cases with a full stomach.

I hope this info helps.

 

[jetproppilot]

Does it work? I'm glad you asked. Apparently, opinions differ to it's effectiveness. Some have said that their patients regurgitated in spite of applying Sellick's maneuver. Maybe they applied it wrong. Or, maybe it doesn't work. A study in England last year showed that Sellick's maneuver was ineffective against regurgitation.
.

And yet residents continue to emerge swearing by Sellick's effectiveness.

Not the residents fault.

<sigh>

When is academic anesthesia gonna be modernized?