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Should residents do a few of these in their training? Is anyone proficient at them? Does digital intubation have a role in management of the difficult airway?
Digital Intubation
- Thread starter BobBarker
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Good questions. I've only practiced this on manikins because I was curious (it was easy on the manikins), but never on a real patient.
With all of the resources available in the OR, I would not consider this anywhere near the top of my list of tools. I think its main use might be in military field/tactical environments where maybe you want to intubate a person, but are afraid the light of the blade may give away your position. Or simply because you have limited to no resources. And even that is probably pushing it.
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I have done it twice in the last 6 months.
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Electively?
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I've tries a couple of times but without success, i doubt it would be my go to move in case the S hits the F
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He must be moonlighting at the zoo.
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Please elaborate on these cases?
I remember learning this in paramedic school, it was exceptionally difficult anyways because of my small hands, but the biggest thing I took from it was "I'm never going to cram my hand this far into someone's mouth"..
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I had an attending who dissuaded people from putting fingers in patient mouths by applying a nerve stim to the masseter/temporalis ...
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I'm glad you approve.
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not elective
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Holy smokes. Not elective? Had you exhausted all other techniques to place an ETT? Or, were they markedly bloody airways, or some other crazy circumstance that needed blind (and potentially desperate) technique? Genuinely looking forward to elaboration of these cases.
Thanks,
GTB
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ive done this once or twice as practice when i was a resident. i would never try this in a CNI/CNV situation unless there were no knives or needles. with that said, it might not be a terrible thing to practice just in case.
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Goodness nothing crazy/ desperate like that at all. When I say "not elective" I mean I didn't go to sleep with my primary airway plan being digital. I used it much like I would reach for a different blade or a bougie after trouble with my first look.
The first case was a six-year-old ish child who swallowed a coin. I had that pediatric stylet that isn't very stiff and I was able to get the tip of the tube onto the larynx just outside the arytenoids, but didn't have quite enough bend in the stylet and when I tried to pass the tube, it bent with the bend going down into the esophagus. I could have pulled the tube out and re-bent the stylet and successfully intubated, but instead I set down the laryngoscope and did it digitally.
Second case, anterior adult male. Should have used a Miller, but had a Mac loaded up from a previous case so took a look. Grade three view. Decided to do it digitally for the hell of it. Could just as easily have done it with a Miller, but saved a few seconds of taking off gloves, getting out a Miller, replacing gloves etc.
No different than grabbing a Glidescope/ second blade/ etc.
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