the bougie

[supahfresh]

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I had a healthy lady today with an easy airway so figured I mess around a little and tried the bougie for the first time. I only had one problem...once I took the laryngoscope out, I couldn't thread the tube through the cords. So, do you guys keep the laryngoscope in until you get the tube threaded? Someone told me to just twist the tube a little to get it unstuck. I also couldn't feel the rings so would you guys guess that the tip of my bougie was pointed posterior?

Tomorrow we are going to thread an LTA through the tube and bougie off the LTA. Anyone try this?

What are some other good airway tricks to try? A CA-3 told me that he purposely gives himself the worst view of the cords first and sees if he can handle it.

 

[jetproppilot]

I had a healthy lady today with an easy airway so figured I mess around a little and tried the bougie for the first time. I only had one problem...once I took the laryngoscope out, I couldn't thread the tube through the cords. So, do you guys keep the laryngoscope in until you get the tube threaded? Someone told me to just twist the tube a little to get it unstuck. I also couldn't feel the rings so would you guys guess that the tip of my bougie was pointed posterior?

Tomorrow we are going to thread an LTA through the tube and bougie off the LTA. Anyone try this?

What are some other good airway tricks to try? A CA-3 told me that he purposely gives himself the worst view of the cords first and sees if he can handle it.

The bougie is a deft adjunct for the anesthesia provider trying to intubate, but can't get the tube to go where they want. Maybe you see the bottom of the aretynoids, maybe you see everything but the damn tube isnt cooperating, maybe you see nothing but you know, because you wield the force, where the cords are.

Visualize as best as you can, provide yourself the best view possible, stick the bougie in. But you are not done yet.

For best results, keep your position....just like you are trying to intubate...and have an assistant thread the ETT over the bougie. Works best with some KY jelly facilitating the threading.

Remove the laryngyscope and you drastically reduce the chances of getting the tube in.

SO, hold your ground, keep the scope in, and thread the ETT over the bougie WITH the laryngyscope in position....for best results.

 

[militarymd]

Tomorrow we are going to thread an LTA through the tube and bougie off the LTA. Anyone try this?

through the murphy eye?

yes

works only OK

 

[zippy2u]

If ya wantta get all cowboy and all, let us know when you can routinely intubate with just a cheap tongue depressor. ---Zippy

 

[toofache32]

If ya wantta get all cowboy and all, let us know when you can routinely intubate with just a cheap tongue depressor. ---Zippy

...from the foot of the bed.

 

[Noyac]

Sometimes when the ETT will not pass you can manuever it through the cords by rotating counterclockwise. This move rotates the beveled end of the ETT towards the larger opening of the cords (anteriorly) and will free the ETT from hanging up on the cords. Also some external traction ( from side to side)at the site of cricoid pressure can help with passing the ETT.

 

[jetproppilot]

Sometimes when the ETT will not pass you can manuever it through the cords by rotating counterclockwise. This move rotates the beveled end of the ETT towards the larger opening of the cords (anteriorly) and will free the ETT from hanging up on the cords. Also some external traction ( from side to side)at the site of cricoid pressure can help with passing the ETT.

Med students and residents,

I hope youre getting the feel from the practicing-posters here that things that seem like bed-wetting scenerios when in residency are normal day occurrences in private practice....I don't know why that is...maybe academic attendings like to "play up" scenerios, maybe they are not comfortable with difficult situations,...I dont know.

What I know is that subjects like taping-the-tube-properly, whats-the-best-blade-to-use, difficult airways, even malignant hyperthermia...

all these scenerios present themselves in the "real world"...but their impact is minimized, not maximized.

They are handled for that crucial twenty minutes, we go on to the next lap chole, and call our wives in the mean time.

 

[Noyac]

bed-wetting scenerios when in residency are normal day occurrences in private practice....

Funny **** man

 

[Noyac]

Funny **** man[/QUOTE]


I just figured out that you can't type curse words here.

**** is actually ****

 

[Noyac]

I don't know why that is...maybe academic attendings like to "play up" scenerios, maybe they are not comfortable with difficult situations,...I dont know.

I was just wondering if there are any attendings that are on this site and if they are paying attention? If so I would like to hear a response to this. I'm sure they disagree and I can remember attendings that were the exact opposite of this but I also remember attendings that were identical to this statement. I also believe that some residents become attendings in there departments because they are not really comfortable with their skills at the end of residency and have a fear of venturing out of the realm of their secure environment. I may be wrong but that is the feeling that I got from some. Don't get me wrong, I have alot of respect for the attendings and I know that this does not describe the majority.

 

[jetproppilot]

Funny **** man

I just figured out that you can't type curse words here.

**** is actually ****[/QUOTE]

 

[supahfresh]

I got it! I tried it again today and it was smooth. This time I was working with a different attending and she told me to take out the laryngoscope because that's what you will have to do when it is really a difficult airway. anyone agree?

 

[militarymd]

I just figured out that you can't type curse words here.

**** is actually ****

[/QUOTE]


You can say ******* .....if you want

 

[jetproppilot]

You can say ******* .....if you want[/QUOTE]

HAHAHAHAHAHAHHAHAHAHAHAHAHAHAHAH

 

[beezar]

Why take the laryngoscope out? It moves all of the soft tissue out of the way so you can thread the tube more easily.

But the real reason why the tube gets hung up is exactly what Noyac said... the bevel gets caught on the arytenoids, so rotating it counterclockwise 90 degrees makes it pass more easily. There is a great picture of the ETT getting hung up on the arytenoids on the cover of Anesthesiology a few months back, along with a study in that journal showing that this is the most common reason for ETTs getting hung up.