Nasotracheal intubation tip

If you're stuck doing a nasotracheal intubation, the major problem is getting the tube to go anterior so it'll intubate the larynx.  We do have the "Endotrol" tubes which have a loop that you can use to pull the tube anterior, but if you don't have that, here's a trick.

Use lots of lidocaine jelly into whichever nostril you pick.  Put the tube in.  When you get to the pharynx, inflate the cuff--that'll push the tube anterior.  Advance the tube, and then when you're in the larynx deflate the cuff and intubate past the cords.  Then inflate the cuff again.