Ever since the BEAM (Bougie Use in Emergency Airway Management) trial was published in JAMA in 2018, the use of the bougie has become increasingly mainstream.

Some of the advantages of using a bougie are known, but there are also misconceptions about its use, how to maximize success with it, and why we should be using it for most, if not all, airways.

The best way to master the bougie is practice. While the bougie has been around for almost three quarters of a century, it is still widely seen as a backup “adjunct.”

However, recent evidence and forward-thinking emergency physicians are starting to change that paradigm.

The widespread use of “bougie first” has the potential to revolutionize emergency airway management, leading to better outcomes for patients.

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