Bougie Assisted Endotracheal Exchange with Intubating SupraGlottic Airways (LMAs). Rehashing Old Lessons. The Shin Maneuver.

October 9, 2018


REALLY is the look the Joker is showing now. Hmmm. Who is this Joker called Torres who is taking advice from a younger doctor.

But sometimes the Joker can be So So Serious. This other Joker with some serious advice for me is called Richard Shin of DOWNSTATE, and Sim Director at my Shop. 



I won't be using a plunger like device that was designed by  Dr. Cook of Air-Q, an intubating LMA like device.


Nor will I use another Endotracheal tube for removal of the LMA like device after succcessful blindly  or fiberoptically placed endotracheal tube. 


I don't like using another Endotracheal tube either as this possible plunger as well. Both methods risk the pilot cuff getting stuck within the lumen of the Laryngeal Mask. 


I think  a better way I learned from Dr. Richard Shin of NYPQ Simulation and Emerg. Use the bougie to exchange out the endotracheal tube recently placed in the Trachea. Then remove the Laryngeal Mask. Then place the desired size endotracheal tube back in over the Bougie. Truly a magnificent piece of plastic. This Endotracheal Introducer/Exchanger called the Bougie.


THE GOOD: Correct technique. I still have to be careful pushing down hard enough on the bougie to make sure pulling out the lma like device, in this case, the I-gel, doesn't dislodge the endotracheal tube out of the trachea.



THE BAD: Here below is the incorrect way of doing the Richard Shin Maneuver





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