Blind digital intubation

Overview

• First introduced in 1880 when William MacEwan administered anesthesia through a metal tube inserted into the trachea by touch
• Fell out of favor in 1907 with introdution of laryngoscopy

Indications

• Can be considered in any patient requiring endotracheal intubation
• Can be used as a rescue method when traditional laryngoscopy fails
• Especially useful in:
  • Austere environments where laryngoscopy is not accessible
  • Out-of-hospital situations where patient is in confined space and cannot be extricated
  • Copious secretions, blood or vomitus obscuring visualization of airway
  • Cervical-spine precautions
  • Grade III/IV Cormack-Lehane view with laryngoscopy

Contraindications

• Severe facial trauma prohibiting endotracheal intubation via the oropharyngeal route

Equipment Needed

• Disposable gloves
• Endotracheal tube

Procedure

1. Insert the index and middle fingers of the nondominant hand into the oral cavity

2. Trace volar surface of fingers over dorsal surface of the tongue

3. Palpate and lift epiglottis

4. Insert ETT with dominant hand

5. Lifting epiglottis with index finger, use middle finger to guide tube through vocal cords.

Complications

• Trauma to provider from patient's teeth

See Also

Airway Pages

• Pre-intubation
  • Predicting the difficult airway
  • Bag valve mask ventilation
  • Apneic oxygenation
    • EBQ:ED Preoxygenation
• Induction
  • Critical care quick reference
  • Rapid sequence intubation
  • Delayed sequence intubation
• Intubation
  • Intubation (peds)
  • Direct laryngoscopy
  • Video Laryngoscopy
  • Bougie
  • The difficult airway
  • Advanced airway adjuncts
    • Supraglottic airway
  • Non-traditional intubation
    • Awake intubation
    • Nasal intubation
    • Blind Digital Intubation
• Surgical airways
  • Surgical cricothyrotomy
  • Needle cricothyrotomy
  • Pediatric jet ventilation
• Post-intubation
  • Mechanical ventilation (main)
  • Deterioration after intubation (DOPE)

References

1. Hardwick WC, Bluhm D. Digital intubation. Journal of Emergency Medicine 1984; 1: 317– 20.