title: 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.
authors.affiliation: Prehospital Emergency Department (AP-HP), Hôpital Henri Mondor, Créteil, France. xavier.combes@hmn.ap-hop-paris.fr
authors.forename: X
authors.initials: X
authors.lastname: Combes
authors.forename: F
authors.initials: F
authors.lastname: Soupizet
authors.forename: P
authors.initials: P
authors.lastname: Jabre
authors.forename: A
authors.initials: A
authors.lastname: Margenet
authors.forename: J
authors.initials: J
authors.lastname: Marty
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000032:analysis; D004632:Emergency Medical Services / Q000379:methods*; D017809:Fatal Outcome; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D008297:Male; D009767:Obesity, Morbid / Q000150:complications*; D012131:Respiratory Insufficiency / Q000150:complications* / Q000628:therapy
chemical_list: D002245:Carbon Dioxide