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Endotracheal tube introducers (gum elastic bougie) for emergency intubation

Aaron E Bair, MD, MSc, FAAEM, FACEP
Erik G Laurin, MD, FAAEM
Section Editor
Allan B Wolfson, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


The endotracheal tube introducer (ETI) is an effective and inexpensive adjunct to difficult airway management that is easy to use. We recommend that an ETI be readily available in every emergency department.

This topic will review the types of ETIs, indications and contraindications for their use, proper technique for using the devices during emergency tracheal intubation, and evidence of their effectiveness. Other airway devices and aspects of emergency airway management are discussed separately. (See "Devices for difficult emergency airway management outside the operating room in adults" and "Advanced emergency airway management in adults" and "Rapid sequence intubation for adults outside the operating room" and "Emergency airway management in children: Unique pediatric considerations".)


Several terms are used to describe the classic endotracheal tube introducer (ETI). Although the phrase "gum elastic bougie" is common, we find it confusing since the ETI is neither gum nor elastic and is not used as a bougie (ie, dilator). In this topic, we will refer to the device as an endotracheal or tracheal tube introducer.

The ETI consists of a 60 cm stylet with the distal tip bent at a 30 degree angle. The bend allows the intubator to direct the tip anteriorly under the epiglottis and through the vocal cords, which may not be visible.

Dimensions and use are comparable among the three main types of ETI available:

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Literature review current through: Dec 2017. | This topic last updated: Oct 05, 2017.
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