II. 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

III. 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

IV. 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

V. 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

VI. Resources

  1. Digital Endotracheal Intubation Video (Shipsey)
    1. http://www.youtube.com/watch?v=prSjvfPrP1o
  2. Images
    1. Larynx - posterior view
      1. entLarynxPosteriorGrayBB952.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
    2. Larynx - superior view
      1. entLarynxSuperiorGrayBB955.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)

VII. References

  1. Shipsey in Majoewsky (2013) EM:Rap 13(5): 5
  2. Stewart (1984) Ann Emerg Med 13(3): 175-8 [PubMed]

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