To assess proper placement of the ETT, the chest and abdomen are inspected for movement. If the tube is properly placed, symmetric movement of the thorax with minimal movement of the abdomen should be seen with each ventilation. Breath sounds should first be assessed over the epigastric area and then over left and right lung fields. Equal breath sounds are typically heard bilaterally with proper endotracheal intubation. If breath sounds are heard over the epigastric area only, it is likely that an esophageal intubation has occurred.
If breath sounds are heard over one hemi thorax, but are diminished or absent over the other hemi thorax, the tube should be left in place. The ETT should be withdrawn 2-3 cm and chest auscultated to check breath sounds again. A common complication of EI is right main stem intubation.9Since the right main stem bronchus has a straighter alignment with the trachea than the left main stem bronchus, an ETT advanced too far will typically enter the right main stem bronchus. In this situation, breath sounds may be heard more prominently or exclusive over the right lung field. Although a deep ETT placement is the most common case of unequal breath sounds, it is important to remember that other clinical conditions can cause unequal breath sounds including consolidation, obstruction, pneumothorax, hemothorax, and pleural effusion.
ETT placement can also be confirmed by use of an end-tidal CO2monitoring. A chest radiograph should always be done in emergency intubations to confirm ETT placement since equal breath sounds can be heard in up to 60% of right main stem intubations. Fiberoptic bronchoscopy has been suggested as a more reliable means of confirming ETT position over clinical assessment.
1. Pulse before, during, and after.
2. EKG before, during, and after, if available.
3. Repiratory rate before, during, and after.
4. Breath sounds before, during, and after.
5. Level of Consciousness (LOC) before, during, and after.
6. Spontaneous and Positive Pressure volumes.
7. Ventilator settings, especially PIP required to deliver the Vt.
8. PF and VC before and after.
9. Sputum production.
11. Blood pressure, if available, before, during, and after.
12. SpO2, if available, before, during, and after.
13. ICP in patients for whom ICP is of critical importance.
14. Chest radiograph, if available.
15. Patient's subjective response to therapy: pain, discomfort, dyspnea, improved, same, worse.