Jetpearl Number 6

[jetproppilot]

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The Eschmann (how do you spell Eschmann?)...I call it the Boojee (pronounced boo-jee) has literally transformed difficult airway management for me. Ironically I was not introduced to it until after my residency. Countless times when dealing with the chinless/obese(everybody is obese where I live)/known difficult airway THIS LONG STRAW LOOKING THING has saved me from the time consuming path of calling for extra airway stuff after laryngoscopy failed to provide a sufficient view for endotracheal intubation. It is a rare occurrence for me to not be able to at least pass the Boojee. Not uncommonly you, the anesthesiologist, may be able to partially view the glottis, but cannot pass the endotracheal tube in the difficult airway. Enter the Boojee....pass the straw thru the cords....you don't need to see much... then Seldinger the tube.

If I can do it, so can you.

There should be a Boojee in every single operating room you practice in, at your finger tips for when you find yourself in a situation like I described above.

It'll save you alotta time and headaches.

 

[IlDestriero]

The Eschmann (how do you spell Eschmann?)...I call it the Boojee (pronounced boo-jee) has literally transformed difficult airway management for me. Ironically I was not introduced to it until after my residency. Countless times when dealing with the chinless/obese(everybody is obese where I live)/known difficult airway THIS LONG STRAW LOOKING THING has saved me from the time consuming path of calling for extra airway stuff after laryngoscopy failed to provide a sufficient view for endotracheal intubation. It is a rare occurrence for me to not be able to at least pass the Boojee. Not uncommonly you, the anesthesiologist, may be able to partially view the glottis, but cannot pass the endotracheal tube in the difficult airway. Enter the Boojee....pass the straw, Seldinger the tube.

If I can do it, so can you.

There should be a Boojee in every single operating room you practice in, at your finger tips for when you find yourself in a situation like I described above.

It'll save you alotta time and headaches.

The Bougie used to be taped to every machine where I worked. Sometimes I pull it out for the residents/fellows. It's useful in the older peds difficult airways as well. Most have never/rarely tried one before. I think that the light wand may be a dying art as well.

 

[jetproppilot]

The Bougie used to be taped to every machine where I worked. Sometimes I pull it out for the residents/fellows. It's useful in the older peds difficult airways as well. Most have never/rarely tried one before. I think that the light wand may be a dying art as well.

B-O-U-G-I-E!!!

Got it, bro.

Thanks.

 

[Jeff05]

where do you get these? available on line?

 

[SexPanther]

Have been using it since day 1 of CA-1. I'm actually surprised that these aren't present at every training institution.

 

[IN2B8R]

The Eschmann (how do you spell Eschmann?)...I call it the Boojee (pronounced boo-jee) has literally transformed difficult airway management for me. Ironically I was not introduced to it until after my residency. Countless times when dealing with the chinless/obese(everybody is obese where I live)/known difficult airway THIS LONG STRAW LOOKING THING has saved me from the time consuming path of calling for extra airway stuff after laryngoscopy failed to provide a sufficient view for endotracheal intubation. It is a rare occurrence for me to not be able to at least pass the Boojee. Not uncommonly you, the anesthesiologist, may be able to partially view the glottis, but cannot pass the endotracheal tube in the difficult airway. Enter the Boojee....pass the straw thru the cords....you don't need to see much... then Seldinger the tube.

If I can do it, so can you.

There should be a Boojee in every single operating room you practice in, at your finger tips for when you find yourself in a situation like I described above.

It'll save you alotta time and headaches.

Word. It is my go to device as well.👍

 

[GasEmDee]

Have been using it since day 1 of CA-1. I'm actually surprised that these aren't present at every training institution.

This is also a device I have used since being a CA-1. My fallback device of choice is situation dependent (e.g., anterior airway, prominent epiglottis, severe anatomic distortion), but some of my favorite go-to tools include:

1) the bougie (ubiquitous)
2) a regular tube styletted into a hockey stick
2) the airtraq
3) fiberoptic intubation via an LMA and aintree catheter
4) glidescope

Sometimes I like the lightwand.

In the VERY RARE circumstance where I suspect a poor view AND a difficult mask, I will topicalize and do an awake look with a glidescope. If I get a good view with that, I will induce. Otherwise I will do an awake fiber (almost never necessary).

 

[Mman]

I love the bougie. It's almost rote for me to go grab one when the CRNA is struggling to get the tube in. I figure if they are struggling, I might as well make it as easy as possible for myself and there is no situation where it will be more difficult to pass the bougie than it is to pass the tube. Even if you have a grade 1 view, sometimes the ETT can be difficult to get between the cords. The bougie has such a small diameter, however, that it's quite easy to get between the cords if you have any sort of view at all. And once you're in the trachea with the bougie it's like every other modified seldinger technique that we do all the time for central lines or perhaps alines.

 

[Licoricestick]

I love the bougie. It's almost rote for me to go grab one when the CRNA is struggling to get the tube in. I figure if they are struggling, I might as well make it as easy as possible for myself and there is no situation where it will be more difficult to pass the bougie than it is to pass the tube. Even if you have a grade 1 view, sometimes the ETT can be difficult to get between the cords. The bougie has such a small diameter, however, that it's quite easy to get between the cords if you have any sort of view at all. And once you're in the trachea with the bougie it's like every other modified seldinger technique that we do all the time for central lines or perhaps alines.

Definitely. I love the bougie too! Definitely my first and favourite even-a-tiny-bit-difficult airway toy.
But also worth a try on the grade 4. That click-clack feel as it goes along the tracheal rings (best felt on withdrawl) is a pretty good guide.

 

[bostonblaz]

I agree, great tool. To add, if you are at a code or situation where you don't have one, or an airway full of blood/vomit a yankower can be used in the same way, only difference is when you feel the rings, leave the yankower there and use it as a guide for thr tube. Has saved me more then once. Blaz

 

[silvester78]

It was part of my education during residency. We converted a grade 1 or 2 laryngoscopy to grade 3 by slightly withdrawing the blade, and then intubating with the aid of a bougie. Every anesthesia machine has a bougie aside. we also have some cook (R) airway exchange catheters. It can serve as a railway to the tube (the same as the bougie) but also has a channel you can pass some oxygen through
My difficult (non expected) airway scenario is blade- grade 3 or something towards 4 then bougie, and if unsuccesful then LMA fast trach.

 

[Hockeyguy]

Here here! Practice with that bad boy because it has saved my ass more than once in the middle of the night when anest stat is called to some BFE corner of the hospital. Simple and effective and as Jet says not hard to use. There are a few quirks with it though (not many) so practice with it on two or three routine inductions.

 

[BIS40]

ya, luckily we added a private hospital the last 2 years of residency, and we had an english attending trained in england, her and some of the group really taught us about the bougie as opposed to our other hospitals who said nonsense like actually dangerous. I love glidescope, but have made my small group tape disposable blue bougie by sun med on all carts, I also carry orange reusable curled up in my pocket when at work. Best way is to practice on easy airway, loosen up laryngoscopy, make 2-3 view and learn feel. Such a simple, reasonable priced time saver. Supposed to be very popular in England.👍