After a Cormack-Lehane grade 3 view, a gum elastic bougie is passed beneath the epiglottis into the trachea. Which finding confirms tracheal rather than oesophageal placement of the bougie?

• A Free passage of the entire bougie without resistance
• B Palpable clicks as the tip traverses the tracheal rings and hold-up when advanced past about 35 cm ✓
• C Coughing in the anaesthetised paralysed patient
• D Slight resistance throughout its entire length

Explanation

The angled (coude) tip of the gum elastic bougie produces palpable clicks against the tracheal rings and then holds up at the carina or bronchus at roughly 35 to 40 cm, confirming tracheal placement. Free passage without any clicks or hold-up suggests oesophageal placement, which kills distractor A. A paralysed patient cannot cough, eliminating option C.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.