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Thoughts From A Clinician

Thoughts from a Clinician: Do You D-Grip?



One of my favorite subjects to teach, train, or talk about is airway management.  There are so many different ways to perform airway management and each scenario has its own special needs.  It is safe to say that I have been a believer in and doer of one particular way for the last three or more years.  It is called the D-Grip.  I have been utilizing the “D-Grip” technique with a bougie since 2013 and I have not looked back.  Even though I did not come up with the technique, the D-Grip reminds me of the importance to have a deep tool box for airway management.  Although many EMS and critical care providers, including myself, were taught the gold standard of direct laryngoscopy, the worst airway cases may require us to be good at a variety of different airway devices or techniques.  Preparation is key to successful management of any airway, easy or difficult.  Simulation training with and on new techniques, new devices and new information are key blueprint imperatives for success in managing the difficult airway.


The picture above is of how I hold the D-Grip/bougie and ETT.  This is a pocket bougie that I am utilizing in this particular training session.  The D-Grip technique is a simple technique that anyone can utilize with both direct and video laryngoscopy.  The benefit of using this technique is the ability to hold the endotracheal tube with a preloaded bougie in your right had and still perform necessary tasks. An example of this is the use of external laryngeal manipulation to get the appropriate view of the larynx.  External laryngeal manipulation is a difficult maneuver if the clinician intubating is reaching for an endotracheal tube or working with a team that is unfamiliar with the intubator’s needs.  This makes the importance of simulation training even more evident.  Anytime there is a new technique or a new way to do something, train on it before implementing such.  Utilizing the D Grip/bougie technique with a checklist for a rapid sequence intubation makes for a smooth transition to a secured airway.  There are a lot of FOAMed resources out there; research and try it.  I have listed a few for you to go check out.  Give it a try!

A few things to think about before your next shift.  What airway devices do you have?  What is your primary and secondary device?  Do you have a checklist or use another memory aid to guide your airway management?  Are you going to induce the patient – if so, rapid or delayed.  Does all of your equipment work?  Have you performed a thorough airway assessment?  Finally, take the time to practice it.  Practice with your partners, friends, and other colleagues.  It is always a surprise what we learn from each other in simulation training.  It allows us to use other techniques, equipment, and approaches that we may not utilize in the field.

Until next time, be safe, and always think like a clinician!







Klint is a United States trained Critical Care Paramedic, who hold specialty certifications in neonatal and pediatric transport as well as being Flight Paramedic certified (FP-C).  He is currently pursuing a Baccalaureate degree in EMS Management through Western Carolina University.  Klint works full time as Flight Paramedic in the Midwest, USA.  He is also an EMS / Critical Care instructor with DistanceCME.  In addition, Klint is FlightBridgeED’s newest blog author and is heavily involved in Free Open Access Medication Education and EMS Education.  Klint can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or on Twitter at @NoDesat


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