Tactile Orotracheal Intubation

1. See Also
   1. Advanced Airway
   2. Rapid Sequence Intubation
   3. Endotracheal Intubation Preparation
   4. Endotracheal Tube
   5. Endotracheal Intubation Preoxygenation (and Apneic Oxygenation)
   6. Direct Laryngoscope
   7. Video Laryngoscope
   8. Endotracheal Intubation
   9. Extraglottic Device (e.g. Laryngeal Mask Airway or LMA)
   10. Nasotracheal Intubation
   11. Cricothyrotomy
   12. Needle Cricothyrotomy
2. Indications
   1. Endotracheal Intubation in deeply comatose patient AND
   2. Difficult airway
      1. Blood or secretions prevent adequate visualization
      2. C-Spine Immobilization interferes with visualization
      3. Difficult positioning (e.g. on-scene of MVA in over-turned vehicle)
   3. Confirm Endotracheal Tube placement
3. Precautions
   1. Exercise caution with sharp teeth or with patients with variable mental status
   2. Epiglottis may be more difficult to reach in tall, thin men
4. Preparation
   1. Gloves!
   2. Insert bite block (if available)
   3. Stand facing patient's head at their side closest to clinician's dominant hand
      1. Example: Right-handed clinician stands at patient's right side
      2. Positioning is similar to position for assisting intubator with BURP technique or Sellig maneuver
5. Technique
   1. Insert dominant hand's index and middle finger into patient's throat
   2. Advance fingers until they touch the epiglottis
   3. Pull the epiglottis forward and advance along it's posterior surface until reaching the arytenoids
   4. Insert the Endotracheal Tube with the free hand along the clinician's dominant hand palm
   5. Index and middle finger guide the Endotracheal Tube through the glottis
6. Resources
   1. Digital Endotracheal Intubation Video (Shipsey)
      1. http://www.youtube.com/watch?v=prSjvfPrP1o
   2. Images
      1. Larynx - posterior view
         1. Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
      2. Larynx - superior view
         1. Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
7. References
   1. Shipsey in Majoewsky (2013) EM:Rap 13(5): 5
   2. Stewart (1984) Ann Emerg Med 13(3): 175-8 [PubMed]