Bougie Pitfalls

One of the most common mistakes when using a bougie is removing the laryngoscope before railroading the endotracheal tube over the bougie. This will cause the tongue and oropharyngeal structures to collapse posteriorly and potentially inhibit passage of the tube. It is therefore imperative to maintain the laryngoscope in place until the tube has passed through the cords      successfully. If resistance is met with the laryngoscope blade still in place, it is likely that the bevel of the ETT has been lodged against the posterior cartilages, thereby prohibiting its progress. This is easily remedied by retracting the tube 1–2 cm, rotating it 90 degrees counterclockwise, and subsequently advancing the tube again.¹⁵

Conclusion

The best way to master the bougie is practice. While the bougie has been around for almost three quarters of a century, it is still widely seen as a backup “adjunct.” However, recent evidence and forward-thinking emergency physicians are starting to change that paradigm. The widespread use of “bougie first” has the potential to revolutionize emergency airway management, leading to better outcomes for patients.

Dr. Cunningham is a PGY2 emergency medicine resident at Maricopa Medical Center in Phoenix, Arizona, with interests in airway management and critical care. In his free time, he is a mediocre mountain biker and wannabe polyglot.

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