Brazil - Your First Nasal Bougie You will Never Forget.
Credit - SAM Clinical Forum
The combined use of Video Laryngoscopy with other advanced Procedures is well established and can create a powerful strategy with much improved safety.
Dr Marcelo Ramos , Dec. 11 , advanced the art by posting a combined Technique.
1. Patient with predicted difficult airway BMI 32, TMD 5 cm, upper incisors 3 cm forward of inferior, MP 4,
2. Nasal Oxygen was used
3. A highly angled video Laryngoscope was able to view the Glottic opening
4. Placement of a nasal bougie was possible under direct vision.
5. Endotracheal tube was threaded over the Bougie.
Discussion:
1. Nasal Oxygen is highly desirable to produce the oxygenation safety boost and there are 3 methods available. 1.Nasal prongs with a maximum flush. 2. Thrive high volume (up to 70 L per minute) humidified high flow nasal O2 which can give prolonged apnoea oxygenation (Patel , BMJ 2015 vol 70 3, pg. 323-329. ) or Nasal CPAP (TSE PAP) using a nasal CPAP mask as per Dr James Tse.
2. The highly angled VL is essential for these cases.
3. Bougie or FOB may be used to guide the ETT via the nasal or oral route.
Elegant technique by an excellent Brazilian team - Congratulations.
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