Abstract
Tracheal intubation can be a stressful procedure, especially when performed in emergency situations. The introduction of a colorimetric device to detect the presence of exhaled carbon dioxide (co2) has strengthened the assurance that the endotracheal tube (ETT) has been correctly placed. 1. Grmec S Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med. 2002; 28: 701-704 Crossref PubMed Scopus (206) Google Scholar , 2. Ornato JP Shipley JP Racht EM Stovis CM Wrenn KD Pepe PE et al. Multicenter study of a portable, hand size colorimetric end tidal carbon dioxide detection device. Ann Emerg Med. 2001; 20: 223-229 Google Scholar Bilateral equal breaths sounds, moisture in the ETT, visible chest rise, and visualization of the tube passing the vocal cords are important but have not been 100% reliable. Breath sounds can be transmitted to the chest from the esophagus, moisture from the esophagus can be seen in the tube, gastric air can seem to move the chest, and even though the operator claims the tube passed between the cords, sometimes the tube is deflected posteriorly into the esophagus. 3. Clyburn P Rosen M Accidental oesophageal intubation. Br J Anesth. 1994; 73: 55-63 Crossref PubMed Scopus (58) Google Scholar , 4. Andersen KH Schultz-Lebahn T Oesophageal intubation can be undetected by auscultation of the chest. Acta Anesthesiol Scand. 1994; 38: 580-582 Crossref PubMed Scopus (52) Google Scholar , 5. Haridas RP Condensation of tracheal tubes is commonly seen with oesophageal intubation. Br J Anesth. 1995; 75: 115-116 Abstract Full Text PDF PubMed Scopus (6) Google Scholar It appears that the presence of exhaled co2 is the sine quo non evidence of tracheal intubation. CorrectionJournal of Emergency NursingVol. 30Issue 6PreviewAngela T. Zimmerman, MD, Assistant Professor, Department of Anesthesiology and Perioperative Medicine, should have been listed as the last author in the October 2004 Clinical Notebook article: Shoun P, Steelman R, Barber B, Olson M, Pate MFD. Total airway obstruction by a mucous plug relieved with extreme positive pressure: Case report of a pediatric patient. 2004;30:473-4. Full-Text PDF
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