II. Indications
- Endotracheal Intubation in deeply comatose patient AND
- Difficult airway
- Blood or secretions prevent adequate visualization
- C-Spine Immobilization interferes with visualization
- Difficult positioning (e.g. on-scene of MVA in over-turned vehicle)
- Confirm Endotracheal Tube placement
III. Precautions
- Exercise caution with sharp teeth or with patients with variable mental status
- Epiglottis may be more difficult to reach in tall, thin men
IV. Preparation
- Gloves!
- Insert bite block (if available)
- Stand facing patient's head at their side closest to clinician's dominant hand
- Example: Right-handed clinician stands at patient's right side
- Positioning is similar to position for assisting intubator with BURP technique or Sellig maneuver
V. Technique
- Insert dominant hand's index and middle finger into patient's throat
- Advance fingers until they touch the epiglottis
- Pull the epiglottis forward and advance along it's posterior surface until reaching the arytenoids
- Insert the Endotracheal Tube with the free hand along the clinician's dominant hand palm
- Index and middle finger guide the Endotracheal Tube through the glottis
VI. Resources
- Digital Endotracheal Intubation Video (Shipsey)
- Images
- Larynx - posterior view
Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
- Larynx - superior view
Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
- Larynx - posterior view
VII. References
- Shipsey in Majoewsky (2013) EM:Rap 13(5): 5
- Stewart (1984) Ann Emerg Med 13(3): 175-8 [PubMed]