Fluoroscopically guided intubation should be considered in the following cases:

Base of skull fracture

Nasal injuries

Deviation of the nasal septum

Hiatus hernia and gastro-oesophageal reflux - if severe the risk of aspiration may be high

Functional problems such as loss of swallow or gag reflex

Oesophageal or gastric abnormalities e.g. stricture, pharangeal pouch, pharangeal

compression, perforation, fistula - may require fluoroscopically guided intubation

Known oesophageal varices, ulceration or haemangioma (due to possibility of causing trauma)

Postoperative patients who have had upper GI surgery, with or without an anastamotic leak

Trauma from poisoning (e.g. Oral consumption of bleach

Many contraindications are relative and a decision to place an NG tube in

these patients and the mode of intubation may still be taken by more senior

members of the team

In some of these situations use of fluoroscopic guidance can make

intubation safer