Digital (finger/touch) Intubation

[pinkemsprincess]

I was just reading about this in my respiratory chapter, and it made me curious to see if anyone has done this or would. I have not, and I have had the oppertunity, but frankly, it's creepy to me. So what about you?

[KosherMedic]

No, I haven't. I would likely cric someone if my only other option was digital intubation.

[fireflymedic]

I have used it on one patient and that's it. It was a unique situation, and the patient wasn't really a candidate to be cric due to some other issues. It worked, but I prefer to keep my fingers, and wouldn't do so without 'lytics on board so I know that I'm not going to have them bite down on me. Be safe and smart about it there is a time and place for it, but mostly it's fallen out of favor.

[fiznat]

Some of the old school medics around here talk about it, but I've never tried on anything other than a mannequin. I think my hand is too fat and my fingers are too short haha. I don't really understand the utility anyways....

[pinkemsprincess]

Some of the old school medics around here talk about it, but I've never tried on anything other than a mannequin. I think my hand is too fat and my fingers are too short haha. I don't really understand the utility anyways....

I know very few people who have successfully utilized this in the field. I have really small hands, but my fingers are kinda stumpy, I am not sure I could reach. Not to mention, as others have said, the fear of losing my beloved fingers.

[NRPinNEPA]

I have big, long alien fingers, so I can digitally intubate without much difficulty. I would prefer it over a nasal intubation any day.

[DwayneEMTP]

I know very few people who have successfully utilized this in the field. I have really small hands, but my fingers are kinda stumpy, I am not sure I could reach. Not to mention, as others have said, the fear of losing my beloved fingers.

I did a digital intubation a few weeks ago. I didn't need to do it in this manner but it was an 80 year old arrest, no teeth, dentures out before bed, no family present. I was was confident that I was going to push some ALS drugs and leave her so I thought I'd try it in case I ever really needed it. It was successful but not nearly as easy as I'd expected.

Not sure if I'll ever need it or not, and am confident that I'll likely not do it on a pt with teeth, but figured it couldn't hurt to practice...

Dwayne

[croaker260]

The utility of this procedure is intubation in confined, awkward entrapments where you cant get full access to use a traditional visual approach (or foward seated approach- Sky hook) intubation and nasal intubation is not an option.

I have had two opportunities in 19 years to do this. Both were trapped patients sitting in a car, roof was not flapped yet , dash wasnt pulled yet either...so extrication and traditional seated intubation (sky-hook) wasnt an option.

Neither case turned out well in the long run, but neither died for lack of airway control . I was thankful my paramedic instructor insisted we practice this method on a sitting dummy over and over and over. And for the record, neither had IV access, and one would not have been a good candidate for IO due to entrapment and orthopedic injuries. Not that we had adult IO's back then.

That said, I too have fat fingers (big hands...means I ...wear big gloves ) I have found that teaching this over and over again, that since we added the Bougie to our tools, the Bougie combined with digital manipulation makes this MUCH easier over digital manipulation of the tube.

As a side comment, I have also found that mastery of the Sky Hook (AKA Pick AX, or Tomahawk) method of intubation should also be considered and essential skill for these awkward situations as well....and is also seldom taught in most schools.

P.S. To answer another poster....I prefer nasal ANYDAY over digital. But I started before the era of RSI, and Nasal was a mainstay of paramedic practice back then.

Edited March 26, 2010 by croaker260

[pinkemsprincess]

The utility of this procedure is intubation in confined, awkward entrapments where you cant get full access to use a traditional visual approach (or foward seated approach- Sky hook) intubation and nasal intubation is not an option.

I have had two opportunities in 19 years to do this. Both were trapped patients sitting in a car, roof was not flapped yet , dash wasnt pulled yet either...so extrication and traditional seated intubation (sky-hook) wasnt an option.

Neither case turned out well in the long run, but neither died for lack of airway control . I was thankful my paramedic instructor insisted we practice this method on a sitting dummy over and over and over. And for the record, neither had IV access, and one would not have been a good candidate for IO due to entrapment and orthopedic injuries. Not that we had adult IO's back then.

That said, I too have fat fingers (big hands...means I ...wear big gloves ) I have found that teaching this over and over again, that since we added the Bougie to our tools, the Bougie combined with digital manipulation makes this MUCH easier over digital manipulation of the tube.

As a side comment, I have also found that mastery of the Sky Hook (AKA Pick AX, or Tomahawk) method of intubation should also be considered and essential skill for these awkward situations as well....and is also seldom taught in most schools.

P.S. To answer another poster....I prefer nasal ANYDAY over digital. But I started before the era of RSI, and Nasal was a mainstay of paramedic practice back then.

Okay, that makes sense. Except the " Sky Hook", never heard of it. But none of this is covered very well at all in school, nor even Nasal intubation.

[JakeEMTP]

Princess, I would never try and speak for someone else, but I believe croaker is speaking of a technique called the "tomahawk" method around here. Basically, it can be used when you are either behind the pt. ie: they are up against the windshield, and the traditional method of intubation is impossible or you can't get to the airway do to the position of the pt.. I could also be totally off base here though . If you ever have the opportunity to attend "The Difficult Airway Course" I highly recommend it. You will learn some techniques which will improve your intubation success rate.

No, I have never digitally intubated a pt. in my short career. I don't think I would unless it was a similar situation as Dwayne described. However, one never knows which sort of situation they will be placed in from day to day, so I can't say I never would.