In a few words 4: Cricoid pressure or BURP
Jeff Kenneally – www.Prehemt.com
Gastric content aspiration is a risk for many patients. Methods to reduce this risk are valuable with intubation arguably the most comprehensive. Cricoid pressure and laryngeal manipulation are manual adjuncts used during intubation that look similar but serve different purposes.
Cricoid pressure is downward pressure applied on the cricoid cartilage with the thumb and forefinger to unconscious patients. This intends to compress the soft oesophagus beneath to stop gastric content outflow. This may not always work in reality as the oesophagus may roll away to one side. The pressure applied should be firm enough to blanch the fingertips. It can risk tearing the oesophagus during active vomiting where it should not be applied. Cricoid pressure can make intubating and ventilation more difficult and stop correct supraglottic airway placement. Once applied though it should be held until either the airway is secured or it causes problems.
Laryngeal manipulation or backwards upwards rightwards pressure (BURP) is different. The thumb and forefinger are used to press down on either side of the larynx just above the cricoid cartilage. This has no impact on the oesophagus or aspiration. Instead BURP can move the larynx downward to help improve the vocal cord view. This may be useful at any time but particularly where a cervical spine injury stops sniffing position use.
The two methods can be used at the same time and by the same person. It must be remembered that both perform a different function. One to prevent aspiration, one to assist cord view.