Cite this post as:
Scott Weingart, MD FCCM. Modification of Scalpel Finger Bougie Technique. EMCrit Blog. Published on July 31, 2016. Accessed on July 6th 2022. Available at [https://emcrit.org/emcrit/modification-scalpel-finger-bougie-technique/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: July 31, 2016
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
You finished the 'cast,
Now Join EMCrit!
As a member, you can...
- Get CME hours
- Get the On Deeper Reflection Podcast
- Support the show
- Write it off on your taxes or get reimbursed by your department
.
Get the EMCrit Newsletter
If you enjoyed this post, you will almost certainly enjoy our others. Subscribe to our email list to keep informed on all of the Resuscitation and Critical Care goodness.
This Post was by the EMCrit Crew, published 6 years ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.
Thanks Scott. Again we feel privileged to learn from those that have gifted their bodies to the Human Body Donation Program. They are prepared in a manner similar to what is used by Rich Levitan in Baltimore. We have modified the preparation over the years and the resultant clinical cadavers truly provide human tissue experience that is often indistinguishable from that of the living. Regarding our findings I agree that this warrants caution regarding holdup. However I don’t think it should be avoided (sit down Minh). I think the message is that you can get false positive holdup although usually… Read more »
Thanks so much for addressing this topic, folks. Having taught bougie-aided cric in dozens of cadaver labs, the conclusion I’ve come to is that holdup in a false passage occurs at 15cm (at least in adults) the vast majority of the time. Therefore, I still use holdup, but if it occurs at <15cm, I'm especially wary that bougie may not be in the trachea, and I'm going to palpate again with my finger prior to placing a tube over the bougie. I like Dr. Kovacs' combined end-point above, although of course, since I get paid to be paranoid, even with… Read more »
Edit: what I meant to say is: the conclusion I’ve come to is that holdup in a false passage occurs at less than 15cm (when *not* trying to be uber-aggressive) the vast majority of the time, and holdup in a cric’d trachea occurs at greater than 15cm (at least in adults) the vast majority of the time.
Hi Scott While these are different circumstances, it is an example of an airway adjunct (cook airway exchange catheter) being misplaced, contributing to arrest. The post mortem showed the catheter through the right middle lobe and in the chest wall. How much of each step contributed to the arrest (for example, oxygen through the catheter at 15 lpm wouldn’t have helped even if it was wedged in the RML without perforation), I don’t know, but to answer the question if this sort of thing is possible, this example shows that it is. Rare, but possible. It was enough to change… Read more »
Disclaimer: Zero experience with this in the emergency situation.
BUT, I visited a US top tier Level 1 trauma centre recently as an observer and they have a skin hook in their ‘finger-scalpel-bougie’ packs to hook the anterior wall of the trachea inferior to the incision forward, much in the manner of using a laryngoscope. They say this gives good direct vision of the trachea and makes insertion much easier.
Comments?
Hey Scott,
If you no longer recommend hold up for secondary confirmation and primary confirmation occurs by feeling the bougie pass next to your finger after your finger has already confirmed you are in the cartilage cage, what’s the point of using the bougie at all. Why not use the Scalpel-finger-tube method as per the Paix & Griggs article?
https://emcrit.org/wp-content/uploads/2014/08/EMA-Scalpel-FInger-Bougie.pdf
You would still get the same tactile confirmation of the tube passing by your finger.
Anand
the ET tube and your finger will never be able to occupy the same space
what happens instead is a passing alongside (as one is removed, the other enters)
there is a point at which the tube can go where-ever it likes during that move and it will eventually go where you don’t want it to
the bougie can be placed inside the airway with your finger still there