Digital Intubation
from Rich Levitan’s Site (palpation of the epiglottis and posterior cartilages by the operator) A tracheal tube can also be placed with direct palpation of the epiglottis or larynx. It is easiest in patients with no teeth and a short distance from the mouth to the larynx. Children and edentulous adults are ideal for this procedure. It should not be attempted unless the patient is in cardiac arrest, is pharmacologically paralyzed, or for some other reason is not capable of biting. A stylet is useful for pre-molding the tube and stylet into a large arc, beginning at the middle of the tube and extending to the tip. The stylet should be well lubricated within the tracheal tube to facilitate removal. The procedure is most easily performed from the patients left side (assuming operator is right-hand dominant). Head extension lengthens the distance from the mouth to the trachea and should be avoided. Head and neck flexion may be beneficial, as long as mouth opening is not restricted. Tongue traction may permit further advancement of the fingers. The index and long fingers of the operators left hand are slid over the surface of the tongue until the tip of the epiglottis or the posterior cartilages of the larynx is appreciated. The right hand is then used to rotate the pre-molded tracheal tube and stylet downward between the fingers of
the left hand. The fingertips help direct the tip anteriorly into the larynx. While the left hand stabilizes the tube, the stylet is withdrawn and the tube advanced into the trachea to the proper depth. In order to obtain proficiency with digital intubation, the clinician must have a good appreciation of what the epiglottis feels like while wearing a latex glove. Being able to palpate the posterior cartilages of the larynx can guide correct placement. Appreciating the feel of the epiglottis or being able to reach the posterior cartilages is quite difficult in many adult patients, especially those with prominent upper dentition. Conversely, this is not the case in small children. In practice, digital intubation is rarely used. Potentially in situations of massive bleeding (or other fluids) it theoretically has a role when direct laryngoscopy visualization or other imaging based techniques are impossible. 
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