This common problem is worst with small bougies, such as in this paediatric example of a child with severe burns and a difficult airway. The bevel of the ETT allows the tip of the tube to stick out right (laterally) of the bougie and snag on the right arytenoid cartilage. This can be remedied by withdrawing the ETT slightly (to disengage it from the arytenoid), effecting a one-quarter counter-clockwise rotation of the ETT on the bougie (bringing the bevel and tip of the ETT into a superior midline position snug with the bougie), and then advancing again.
Kudos to both Nicholas Chrimes and the Bromiley family for this excellent learning resource. Free lessons stemming from the bravery and compassion of others.
Picked this up at the Storz booth at a recent meeting. Printed on a 10cm piece of what looks like fairly hard-wearing plasticized card, it looks like it might survive in a pocket or bag for a fairly long time, and can be used to make direct measurements. Useful or gimmick? What do you think?
Blinded intubation through the 3gLM SGA, as viewed by a video endoscope riding inside a Parker Flex-Tip ETT.
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