Unusual placement of an endotracheal tube in a patient with blunt traumatic airway injuries

Abstract

Unfortunately, even today, confirming endotracheal tube (ETT) position after emergent intubation remains an inexact science. All the standard techniques, such as auscultation of bilateral breath sounds, absence of breath sounds in the epigastric area, visible equal chest wall expansion, mist in the ETT tube, direct view of the ETT passing through the vocal cords, appropriate oxygen saturations, and proper color change from the disposable CO 2 detector are at times, imprecise, impractical, or misleading. 1,2 With these limitations, however, the airway is thought to be properly secured and the patient properly ventilated if adequate oxygen saturation and CO 2 color detection are achieved and the ETT is secured at a reasonable depth in the trachea. We present a case of blunt thoracic trauma managed by a flight nurse with prehospital intubation that challenges this notion. Later it was discovered that the tube took an unusual route of passage.