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Out of hospital difficult intubation resolved with nasotracheal use of a gum elastic bougie

Abstract

We report the case of a 30 year old man managed in an out of hospital setting for a cardiorespiratory arrest. The patient was impossible to intubate under direct laryngoscopy because of a severe mouth opening limitation associated with a buffalo neck. After failure of direct laryngoscopy and intubating laryngeal mask airway, an Eschmann tracheal tube introducer (gum elastic bougie) was introduced through a nostril. The bougie could be blindly inserted into the trachea, and the patient was intubated using the bougie as a guide. Tracheal intubation was then confirmed using the syringe aspiration test and end tidal carbon dioxide detection.

  • GEB, gum elastic bougie
  • ILMA, intubating laryngeal mask airway (ILMA)
  • out of hospital
  • cardiopulmonary resuscitation
  • airway management
  • difficult intubation

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