Article Text

BURP and laryngoscopy
Free
1. Simon Carley,
2. Rupert Jackson
1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

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Report by Simon Carley;Specialist RegistrarChecked by Rupert JacksonSpecialist Registrar

## Clinical scenario

A 35 year old man with a severe head injury is brought to the emergency department. He has fallen from a ladder and is leaking CSF from the left ear suggesting a base of skull fracture. He has a GCS of 3 and dilated pupils. There are no other apparent injuries. You decide to intubate him using an RSI technique. Laryngoscopic view is poor despite the use of a McCoy laryngoscope and cricoid pressure. You eventually intubate using a gum elastic bougie. Your assistant performing cricoid pressure asks during the procedure if you want a BURP. Other bodily functions come to mind! Later your colleague explains that BURP (backwards, upwards, to the right, with pressure) on the thyroid cartilage improves the view. You wonder if in fact it is any better than simple cricoid.

## Three part question

In [patients in with a poor laryngoscopic view] is [the BURP technique better than simple cricoid pressure] at [improving laryngoscopic view]?

## Search strategy

Medline 1966–07/2001 using the OVID interface. [{exp laryngoscopy OR laryngoscopy.mp OR exp intubation, intratracheal OR intubation.mp OR intubate$.mp} AND [{(back.mp OR backward$.mp OR posterior.mp) AND pressure.mp} OR BURP.mp] LIMIT to human AND english.

## Search outcome

Altogether 72 papers were found of which three were relevant to the three part question. These three papers are shown in table 2.

Table 2