Funny you say that about bougies - I’m phasing our regular stylets for bougies at work. I’ve always been a fan of the bougie, the study by Driver et al was pretty convincing evidence that it’s time to dump the traditional stylet..Not all of us are that bad, but the amount of times I have heard the phrase, "Bougies are for people who can't intubate" or "Why would i ever use suction?" Is pretty high. Curious if we are going to get the DeCanto suction though. That said, there isn't much incentive to improve aside from your own desire to better the patient, and you know how most of our co workers are.
In response to the thread, you basically have two options, be a bad medic and force the tube then sedate, or manage with a BLS airway and advise the hospital to have RSI ready. Had it happen to me earlier in the week, GCS of 7 with strong localization, and it's a choice of either doing something without the right equipment and medication, or manage the airway with an OPA and BVM.
As a side note, in general I feel frustrated more than satisfied in a lot of ways, we had a protocol update a year prior that never went into effect, still no official sepsis protocols, and a disincentive to using EtC02 for anything but pure respiratory reasons. I could list the things that frustrate for a while, but I'm starting to realise that the only thing I can do is improve my own practice as best I can.
I also recently put DuCanto tips in service..
As for your issues with End-Tidal, what's their motivation for devaluation? I'm guessing cost, which is unfortunate. Are they even aware of how widespread EtCO2 is becoming? Do they understand acid-base balance and WHY end-tidal is an indicator of an anaerobic metabolism (i.e. sepsis, poor perfusion, etc).. Very frustrating for sure, sounds like you're moving backwards..