Bougie-Facilitated Intubation Using the Bougie as a rescue device can sometimes be complicated with difficulty advancing the endotracheal tube as the tip can get hang up at the level of the glottis. Two things that can help advance the tube: Rotate the tube 90 degrees counterclockwise. Stop holding Cricoid Pressure, especially in female patients A recent study looking at cricoid pressure showed that the frequency of impingement was 38% with sham pressure and 60% with true cricoid pressure. This statistically significant difference was entirely attributable to an effect in female patients. Original Article: McNelis U et al. The effect of cricoid pressure on intubation facilitated by the gum elastic bougie. Anaesthesia 2007 May; 62:456-9. Forget about Sterile Saline and Use Tap Water Irrigation In a multicenter prospective trial of 715 patients, Moscati et al have shown that rates of wound infection were similar (3.3% compared to 4.0%) in patients that received clinician-administered sterile saline irrigation or at least 2 minutes of self-administered tap-water irrigation. The amount (volume) of irrigation is more important than whether the irrigate is sterile or not. Moscati RM et al. A multicenter comparison of tap water versus sterile saline for wound irrigation. Acad Emerg Med 2007 May; 14:404-9.
