Nasotracheal intubation is an essential skill that allows a flexible approach to airway management. These are generally performed with the patient awake and spontaneously breathing and protecting their airway. They can either be performed with a endoscope or blindly.
In order for blind nasotracheal intubation to be successful it requires patient respiratory effort and air exchange so that you can listen for air movement from the end f the endotracheal tube. The Beck Airway Airflow Monitor (BAAM) is a device which when attached to a 15 mm endotracheal tube adapter, magnifies airway-airflow sounds, producing a whistling sound which greatly aids in correct endotracheal tube placement.
Below you can see it attached to the 15mm adaptor of an endotracheal tube.
There are two camps in Fiberoptic Bronchoscope-assisted nasotracheal intubation: Tube-before-Scope and Scope-before-Tube (Roberts and Hedges has a discussion for advantages of each). The BAAM device is only used in the Tube-before-Scope approach. BAAM can be helpful with Fiberoptic Bronchoscope NTI if it is your practice to place the ETT into the hypopharynx before inserting the tube. Ideally, it gets you close enough to the inlet so that, when you place the scope and it peeks out the tube end, the cords are sitting in front of you (The device has a small hole in the end which creates the whistle when the pt breaths- it is not for an scope). BAAM is not