Digital Intubation: you want me to put my fingers where?

7 Jun

Roberts and Hedges describes this procedure as an adjunct for direct laryngoscopy, citing two papers from the 1980’s and 90’s.

 

Consider using this technique in the deeply comatose patient whose larynx cannot be visualized and who has a contraindication to NT intubation. Or just to practice with the goal of expanding your airway arsenal.

 

Advantages include speed and ease of placement, less anatomic constraints, and little neck movement.

 

Contraindications are aimed at protecting the fingers of the clinician. Do not attempt in an agitated patient or any patient who may be at high risk for biting your fingers.

 

How it’s done:

Stand at the patient’s right side, facing the patient’s head.

Slide your right index and middle fingers into the patient’s mouth along the surface of the tongue until the epiglottis is felt (about 8-10 cm from the corner of the mouth).

With your left hand, introduce a lubricated tube between the tongue and the rescuer’s two fingers. 

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Cradle the tube between two fingers and guide the tip beneath the epiglottis.

Apply gentle anterior pressure to direct the tube into the larynx.

 

More recently, the May EMRAP podcast provides a nice overview and recommends this video link:

http://www.youtube.com/watch?v=prSjvfPrP1o

 

Submitted by K. Estes.

 

References: Stewart, RD. Tactile orotracheal intubation. Ann Emerg Med. 1984 Mar;13(3):175–‐8.; Roberts J, Hedges J, editors. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier, Inc; 2010.

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