During a difficult laryngoscopy, only the epiglottis is visible. A gum elastic bougie (Eschmann introducer) is passed beneath the epiglottis and advanced blindly. Which finding confirms tracheal rather than oesophageal placement of the bougie?
- A Free passage beyond 40 cm without resistance
- B The patient coughs immediately on insertion
- C Palpable clicks as the tip traverses the tracheal rings, or hold-up when the carina is reached ✓
- D Loss of resistance felt as the angled tip enters a lumen
Correct answer: C. Palpable clicks as the tip traverses the tracheal rings, or hold-up when the carina is reached
Explanation
The Eschmann bougie has a coudé (angled) tip of about 40 degrees. In the trachea, the tip produces palpable clicks against the cartilaginous rings in up to 90 percent of cases, and further advancement causes hold-up at around 50 to 60 cm as it meets the carina or a bronchus. Free passage without clicks suggests oesophageal placement, since the oesophagus is a straight muscular tube with no rings. Coughing is unreliable in an anaesthetised patient, and loss of resistance is not a recognised sign.
Reference: Benumof and Hagberg's Airway Management, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.