G. Digital intubation 1. Involves directly palpating the glottic structures and elevating the epiglottis with your middle finger while guiding the ET tube into the trachea by feel a. Gives you an option in some extreme circumstances 2. Indications and contraindications a. Digital intubation may be used in the following exceptional circumstances: i. Laryngoscope is not available or has malfunctioned ii. Other intubation techniques have failed. iii. Patient is in a confined space. iv. Patient is extremely obese or has a short neck. v. Copious secretions obscure the airway. vi. Head cannot be moved due to trauma, or immobilization equipment interferes with direct laryngoscopy vii. Massive airway trauma has made visualization of the intubation landmarks impossible. b. Can be performed in pediatric patients, but the size of an fingers relative to the size of adult’s the mouth usually makes the technique impossible. child’s c. Absolutely contraindicated if the patient is: i. Breathing ii. Not deeply unresponsive iii. Has an intact gag reflex 3. Advantages and disadvantages a. Does not require a laryngoscope, so most advantageous in case of equipment failure b. Ideal if the vocal cords are obscured by copious, uncontrollable oral secretions c. Does not require the sniffing position, so it can be performed on trauma patients and patients whose heads cannot be placed in a sniffing position d. The major disadvantage is risk of being bitten. i. Only perform in patients who are deeply unresponsive apneic and e. Risk of exposure to infectious disease if teeth tear through gloves 4. Complications a. Major complication: Misplacement of the ET tube b. Insertion of a bite block or dental prod can cause lip trauma and tooth damage. c. Vigorous attempts at insertion or improper technique can cause airway trauma or swelling. d. Any intubation attempt can result in hypoxia. i. Carefully monitor clinical condition. ii. Limit intubation attempts to 30 seconds. iii. Ventilate appropriately between attempts. 5. Equipment a. Same equipment as required for orotracheal intubation (minus laryngoscope), plus your fingers i. Stylet
G. Digital intubation 1. Involves directly palpating the glottic structures and elevating the epiglottis with your middle finger while guiding the ET tube into the trachea by feel a. Gives you an option in some extreme circumstances 2. Indications and contraindications a. Digital intubation may be used in the following exceptional circumstances: i. Laryngoscope is not available or has malfunctioned ii. Other intubation techniques have failed. iii. Patient is in a confined space. iv. Patient is extremely obese or has a short neck. v. Copious secretions obscure the airway. vi. Head cannot be moved due to trauma, or immobilization equipment interferes with direct laryngoscopy vii. Massive airway trauma has made visualization of the intubation landmarks impossible. b. Can be performed in pediatric patients, but the size of an adult’s fingers relative to the size of the child’s mouth usually makes the technique impossible. c. Absolutely contraindicated if the patient is: i. Breathing ii. Not deeply unresponsive iii. Has an intact gag reflex 3. Advantages and disadvantages a. Does not require a laryngoscope, so most advantageous in case of equipment failure b. Ideal if the vocal cords are obscured by copious, uncontrollable oral secretions c. Does not require the sniffing position, so it can be performed on trauma patients and patients whose heads cannot be placed in a sniffing position d. The major disadvantage is risk of being bitten. i. Only perform in patients who are deeply unresponsive and apneic e. Risk of exposure to infectious disease if teeth tear through gloves 4. Complications a. Major complication: Misplacement of the ET tube b. Insertion of a bite block or dental prod can cause lip trauma and tooth damage. c. Vigorous attempts at insertion or improper technique can cause airway trauma or swelling. d. Any intubation attempt can result in hypoxia. i. Carefully monitor clinical condition. ii. Limit intubation attempts to 30 seconds. iii. Ventilate appropriately between attempts. 5. Equipment a. Same equipment as required for orotracheal intubation (minus laryngoscope), plus your fingers i. Stylet