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Out of hospital difficult intubation resolved with nasotracheal use of a gum elastic bougie
  1. X Combes1,
  2. F Soupizet1,
  3. P Jabre1,
  4. A Margenet1,
  5. J Marty2
  1. 1Prehospital Emergency Department (AP-HP), Hôpital Henri Mondor, Créteil, France
  2. 2Department of Anaesthesia and Intensive Care, Hôpital Henri Mondor, Créteil, France
  1. Correspondence to:
 Dr X Combes
 Service D’anesthésie Réanimation, Hôpital Henri-Mondor, 51 avenue du Maréchal de Lattre-de-Tassigny, 94100 Créteil cedex, France; xavier.combes{at}


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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  • Competing interests: there are no competing interests