While digital intubation is seldom the intubating technique of choice, it remains an important technique in emergency situations when equipment fails or is not available.
Apart from an endotracheal tube, the technique requires no other equipment. However, the technique is substantially easier to perform with the use of a tracheal tube guide or introducer, if it is available.
The patient should be ventilated and oxygenated via bag mask prior to intubation. Provided that there are no contraindications, the patient's head should be placed in the ? SUPINE ? position. The right-handed practitioner should stand on the left side of the patient so that the non-dominant side of the practitioner is closest to the patient.
If an assistant is available, the patient's tongue can be grasped and pulled forward to lift the epiglottis anteriorly to make palpation of the epiglottis easier. The practitioner then places the index and long fingers of his non-dominant hand into the patient's mouth. Once the epiglottis is palpated by the long finger, it is lifted in anterior direction. The intubating guide is then guided into the mouth along the palmar surfaces of the index finger.
The index finger of the non-dominant hand is then flexed to guide the intubating guide under the epiglottis and into the trachea. The endotracheal tube is then advanced over the guide into the trachea. Maintaining anterior traction on the epiglottis facilitates endotracheal tube passage through the vocal cords.
Confirmation of successful tracheal intubation should be determined clinically with devices able to measure end-tidal carbon dioxide.
Segment:3 Trouble Shooting.
Although digital intubation is a simple and easy technique to learn, it is difficult to perform when the epiglottis cannot be identified with the long finger during intubation. This is particularly true for excessively tall patients or patients with a full set of teeth, a small mouth, and a restricted mouth opening.
The procedure can also be difficult to perform if the practitioner has short or large fingers relative to the patient's anatomy. If there are no contraindications, extension of the patient's head will make it easier to feel the epiglottis. Alternatively, external INAUDIBLE laryngeal traction is also helpful. To minimize risk of injury to the practitioner's fingers, digital intubation is generally contraindicated for patients who are awake and are uncooperative.
However, in emergency situations when limited equipment is available a digital intubation can be safely performed with a bite block in place.
In summary, digital intubation is a simple, easy-to-learn lifesaving technique. However, its success depends on the skill of the practitioner and the ability to feel the epiglottis during intubation.