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Digital intubation
The intubator should stand at the patient's right side and be facing the patient. Insert the index and middle fingers of the right hand into the right angle of the patient's mouth. Slide the fingers along the surface of the tongue until the epiglottis is palpated. The metacarpophalangeal joints of the index and middle fingers will usually be at the level of the patient's incisors in an adult. The tip of the epiglottis is approximately 8 to 10 cm from the incisors. Elevate the epiglottis with the index finger. The thumb of the left hand may be used to provide cricoid pressure if needed
With the left hand, insert the endotracheal tube along the left side of the patient's mouth and between the two fingers
A patient's mouth may appear too small to allow an endotracheal tube and two fingers of the intubator. Use the fingers in the patient's mouth to push their jaw and tongue forward. If the patient's mouth still appears small, apply gauze squares over their mandibular incisors and push their mouth open further with the bases of the fingers in their mouth.
It may be difficult to blindly identify the patient's epiglottis. Insert your fingers in the midline of the patient's mouth and slowly push them posteriorly. The fingers will roll off the posterior portion of the tongue and allow you to palpate the epiglottis. Be careful to not push the epiglottis posteriorly. Once identified, move your fingers to the right side of the patient's mouth while the fingertips are in constant contact with the epiglottis. Continue the procedure as described above.
Some may be concerned their fingers are not long enough to palpate the epiglottis. Push the soft tissue in the right angle of the patient's mouth posteriorly while inserting your fingers posteriorly in their mouth. This will allow your fingers to reach more posteriorly