Endotracheal tube introducer for failed intubations: A variant of the gum elastic bougie

There is no universally accepted nonsurgical adjunct for management of the difficult airway in the emergency department. The gum elastic bougie is wid ely accepted in the British anesthesia literature. One model at endotrachea l tube introducer, the Flex-Guide FT Tube Introducer (GreenField Medical So urcing, Inc, Northborough, MA), is a less expensive plastic version of the gum elastic bougie with the same properties, available in the United States . We present 3 cases of its use in obtaining airway control in difficult ai rways in the ED. The bougie facilitates intubation where the cords are not visualized or neck movement is contraindicated, allows verification of corr ect placement before placing the endotracheal tube, is simple to use, and i nexpensive to obtain. Reports of 100% first-attempt intubation success in d ifficult airways are published in the anesthesia literature. We advocate us e of this device in the emergency department as a nonsurgical adjunct for d ifficult airway management.