Ideal for Pts requiring PPV (e.g., pulmonary edema, asthma).

• Contraindications: Intact gag reflex, epiglottitis (pediatric cases), basilar skull fractures (avoid nasal intubation), caustic ingestion, known esophageal disease or trauma
• Immobilize c-spine if indicated
• Pre-oxygenate with 100% oxygen
• Position Pt's head in sniffing position (except for trauma)
• Test patency of balloon: use-10 mL syringe; deflate balloon, but leave syringe attached to inflation port
• Open and assess airway: lift Pt's jaw up, and open
• Remove dentures or foreign bodies, and suction if needed
• Insert laryngoscope blade: insert in right side of mouth
• Sweep tongue left while advancing blade
• Straight blade: insert blade under epiglottis
• Curved blade: insert blade into vallecula
• Bring cords into alignment: without changing angle of blade, lift upward and forward (do not touch Pt's teeth)
• Pass tube under direct visualization: from right corner of mouth, pass tube through vocal cords into trachea
• Withdraw stylet: connect bag-valve device
• Inflate balloon: Use 10 mL of air
• Confirm proper tube placement:
• Auscultate epigastria and bilateral lung fields
• Esophageal/CO₂ detector, capnography, oximetry
• Secure tube: use commercial ETT holder per protocol
• Insertion depth noted at level of Pt's teeth