blind rotation technique for mainstem intubation

24 Jun


Your next patient is a middle aged man who is at first spraying a fine red mist with each cough, then starts bubbling rivers of bloody goodness with each attempted breath.  Your laryngoscope (and hopefully suction and a Bougie) are already in your back pocket.   As you go to intubate, is there anything else you can do here?


You can intubate one lung (nonbleeding lung–if you know which one that is)

RIGHT mainstem bronchus is easy —  just advance standard ETT.


LEFT mainstem more difficult – often requires special equipment.

TRY THIS: Rotate tube to the left (90 degrees) after through vocal cords and advance until resistance met.


You can use this for the RIGHT mainstem, too (rotate 90 degrees toward right lung, and advance until resistance)


The rotation technique successfully intubated the right side 94% and the left 72% of the time (n = 25 in cadaver trial)


Similar results with a directional-tip ET tube (if you have it)


Submitted by J. Andrick.


References: An evaluation of a blind rotational technique for selective mainstem intubation. Bair AE, Doherty MJ, Harper R, Albertson TE: Acad Emerg Med 11: 1105, 2004.; picture


One Response to “blind rotation technique for mainstem intubation”


  1. can’t retrieve that tracheal foreign body? | DAILYEM - September 9, 2013

    […] you want to try and aim for a particular side/mainstem bronchus, look back to THIS POST for a rotational technique […]

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