Saviour May Not Always be a Saviour!

The intubating bougie is commonly used to railroad an endotracheal tube in anticipated or unanticipated difficult intubation. However, literature regarding bougie-induced airway trauma and complications resulting from its use is scarce. We describe a case of a 47-year-old male who suffered head injury following a road traffic accident. With deterioration of his neurological status, tracheal intubation and mechanical ventilation were planned. In view of a possible difficult airway, bougie-guided intubation was attempted. Although the airway was secured at the first attempt with a bougie-guided technique, the patient developed a pneumothorax. Later fibreoptic assessment of the tracheobronchial tree revealed a rent in the posterior wall of left main stem bronchus which was managed conservatively. This case underscores the importance of being cautious while using a bougie to secure the airway and also cautions to limit the number of airway interventions to prevent complications.