Digitally enhanced airway management

CUT symbol - letters made up of bougie, finger and scalpel
CUT symbol – letters made up of bougie, finger and scalpel

Scott Weingart’s surgical airway talk from SMACCGOLD has just been release. PLease check out on this site or at ICN

It got me thinking about the importance of the finger in key rescue airway techniques.

There is the old technique of digital intubation, taught to me by an ex military South African special forces doctor. In fact this has rescued a prehospital airway on at least one occasion I am aware of!

Check out Chris Bonds article on digital intubation here.

It made me think how many airway disasters I knew that a digital intubation was never attempted? I can think of at least 3 well known cases to me! My point is we all seem keen on the latest videolaryngoscope , even when on our hands we carry the tools to do a rescue airway technique that requires no vision and yet if done right can almost certainly rescue the worst failed visual intubation attempt.

Then the surgical airway technique described by Scott, reminded me once again that the finger and digital palpation is the most important element of success of the surgical airway. There are so many ways described in textbooks and courses about how to do the surgical airway and very few stress the importance of using your finger to reliably locate crucial landmarks.

This was reinforced when I was at Sydney HEMS recently and the technique they currently teach is what Scott has described.

Scalpel-finger-bougie technique for surgical airway GSA HEMS style
Scalpel-finger-bougie technique for surgical airway GSA HEMS style

They have learnt through experience and testing that surgical tools like hooks and tracheal dilators in the hands of non surgeons are just too UNRELIABLE. Even when combined with a bougie, I am aware of at least 5 cases of failed scalpel bougie cricothyroidotomy which failed as a finger was NOT used to reliably determine the tracheal lumen.


So really when you think about failed DL and VL, patient is desaturating..LMA is failing. The finger then can help you out 2 ways! Digital intubation attempt or to do a surgical airway! And it costs nothing too!

Now anyone who is a Bruce Lee Fan will recall this famous line from Enter the Dragon “It is like a finger pointing at the moon..”


2 thoughts on “Digitally enhanced airway management

  1. Agree. And I do like the “cut” symbology in your photo.

    Pocket Bougie a good one to have in a pre-made pack, along with scalpel – it’s small enough to have in a bag in either ESA drawer on difficult airway trolley, in prehospital bag or even in pocket of scrubs or flight suit.

    Quick Q – that scalpel in your pic – is it one of those fancy ones with retractable blade? To help reduce sharps injury? Seems that a retractable blade could be a bonus in prehosp environment…or indeed in any CICO crisis when handling of sharp instruments is unanticipated, so no ready sharps/instruments tray.


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