Among the least commonly utilized intubation techniques stands the humble digital intubation. The name says it all: the intubator uses their index and middle finger like a miller blade to locate (by palpation) and lift the epiglottis before gliding the ETT between the fingers into the trachea. More commonly utilized in pre-hospital and tactical situations, there is decent existing evidence for the technique as a failed airway maneuver for paramedic and as an easily-learned proecdure by emergency medicine residents. Advantages of the technique include speed, minimal need for positioning or c-spine movements and ability to perform blind. Disadvantages include need for practice, potential trauma to patient and provider, and the necessity of the patient being paralyzed or comatose.

Regardless, a worthwhile technique to at least be aware of in your next difficult airway. Illustrations of how to perform are below.

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Young SE, Miller MA, Crystal CS, Skinner C, Coon TP. Is digital intubation an option for emergency physicians in definitive airway management? Am J Emerg Med. 2006 Oct;24(6):729-32. PubMed PMID: 16984845.