Im shocked to see him let og of the tube as he inflates the cuff, I work in pre-hospital and ive always been taught religiously not to let that tube go for any reason until its secured
No end tidal CO2 detector? Any inexperienced clinician must consider a yellow ETCO2 (>6 breaths) as the only definitive indicator of correct tracheal placement. Visualization of the tube passing through the chords, followed by proper chest movement--even with auscultation--doesn't mean the ET tube has been placed correctly. Neck flexion should be noted. Also, the Pt should be pre-oxygenated with 100% O2 (surely occurred, yet wasn't mentioned). This is a very poor educational video.
@mourerj Actually, hes right on. Im sure hes performed 100s if not a thousand + intubations. Im not sure this was meant to be educational, if not informative. The gold standard is NOT colormetric end tidal monitoring. If you look closely, he is using quantitative monitoring. But first and foremost, he visualized the tube passing the cords. Physical assessment still trumps "monitors"...and such. I would have liked to see him listen over the epigastrium immediately. But, what do I know?
@mourerj And, Im perplexed. If you SEE the tube pass through the vocal cords AND auscultate NO sounds over the epigastrium and "present" lung sounds bilaterally/axillary.... and can back it up with quantitative ETCO2.... Where did the tube go? Am I missing something here? Im always open to learn.
@Hawgbrew If you visualize the tube pass the chords, then listening over the epigastrium isn't always the first priority. Generally before I even grab my stethiscope I have 3 indicators (visualization of passing through chords, tube fog, waveform waveform ETCO2.) All can be seen on that first breath while you're picking putting your ears on.
I work in the prehospital setting, surgical settings may have a higher standard.
I always listen to epigastrium and lung sounds anyway... CYA people.
@TheSecretJoe I work in the prehospital setting also. I think were on the same page here. There should be three methods of ETT placement. According to American Heart Association (My gold standard), ETT placement should be confirmed by direct visualization, 5-point auscultation (including epigastrium) and end tidal CO2, preferably wafeform/quantitative. As I said before, "physical assessment trumps monitors". While fog in the tube is a "good" indicator of tube placement....cont.
@TheSecretJoe I wouldnt rely on it over the the previously mentioned three, as there could be a myriad of things that would make that ineffective (ie. secretions, blood ect.). Capnography also has room for failure, as it is just another piece of equipment that is not infallible. As an experienced provider, auscultation has proven to be the most consistent indicator of correct tube placement in my experience, even diagnosing RMB intubation. My two cents. Be careful, its a jungle out there!
@mourerj ETCO2 is a fantastic tool, but it is not the ONLY definitive indicator for sure. ETCO2 will not show "proper" placement as R-Mainstem intubations are still possible, and CO2 readings will be accurate (waveform CO2 may read lower than 35-45).
In truth, the ONLY definitive indicator of proper placement is an X-ray.
In my clinical experience, SEEING the tube pass through the vocal cords is my most trusted indicator. But NEVER rely on just one indicator. The standard of care is to have 3.
Comment removed
DrHunterMD 2 weeks ago
vgd
patilpankajsinh 1 month ago
Im shocked to see him let og of the tube as he inflates the cuff, I work in pre-hospital and ive always been taught religiously not to let that tube go for any reason until its secured
ne014x 1 month ago
@ne014x I was just thinkin the same thing. Never let go of the tube and NEVER take the eyes off the vocal cords once exposed
SuperWarking 1 month ago
No end tidal CO2 detector? Any inexperienced clinician must consider a yellow ETCO2 (>6 breaths) as the only definitive indicator of correct tracheal placement. Visualization of the tube passing through the chords, followed by proper chest movement--even with auscultation--doesn't mean the ET tube has been placed correctly. Neck flexion should be noted. Also, the Pt should be pre-oxygenated with 100% O2 (surely occurred, yet wasn't mentioned). This is a very poor educational video.
mourerj 5 months ago
@mourerj Actually, hes right on. Im sure hes performed 100s if not a thousand + intubations. Im not sure this was meant to be educational, if not informative. The gold standard is NOT colormetric end tidal monitoring. If you look closely, he is using quantitative monitoring. But first and foremost, he visualized the tube passing the cords. Physical assessment still trumps "monitors"...and such. I would have liked to see him listen over the epigastrium immediately. But, what do I know?
Hawgbrew 5 months ago
@mourerj And, Im perplexed. If you SEE the tube pass through the vocal cords AND auscultate NO sounds over the epigastrium and "present" lung sounds bilaterally/axillary.... and can back it up with quantitative ETCO2.... Where did the tube go? Am I missing something here? Im always open to learn.
Hawgbrew 5 months ago
@Hawgbrew If you visualize the tube pass the chords, then listening over the epigastrium isn't always the first priority. Generally before I even grab my stethiscope I have 3 indicators (visualization of passing through chords, tube fog, waveform waveform ETCO2.) All can be seen on that first breath while you're picking putting your ears on.
I work in the prehospital setting, surgical settings may have a higher standard.
I always listen to epigastrium and lung sounds anyway... CYA people.
TheSecretJoe 4 months ago
@TheSecretJoe I work in the prehospital setting also. I think were on the same page here. There should be three methods of ETT placement. According to American Heart Association (My gold standard), ETT placement should be confirmed by direct visualization, 5-point auscultation (including epigastrium) and end tidal CO2, preferably wafeform/quantitative. As I said before, "physical assessment trumps monitors". While fog in the tube is a "good" indicator of tube placement....cont.
Hawgbrew 4 months ago
@TheSecretJoe I wouldnt rely on it over the the previously mentioned three, as there could be a myriad of things that would make that ineffective (ie. secretions, blood ect.). Capnography also has room for failure, as it is just another piece of equipment that is not infallible. As an experienced provider, auscultation has proven to be the most consistent indicator of correct tube placement in my experience, even diagnosing RMB intubation. My two cents. Be careful, its a jungle out there!
Hawgbrew 4 months ago
@mourerj ETCO2 is a fantastic tool, but it is not the ONLY definitive indicator for sure. ETCO2 will not show "proper" placement as R-Mainstem intubations are still possible, and CO2 readings will be accurate (waveform CO2 may read lower than 35-45).
In truth, the ONLY definitive indicator of proper placement is an X-ray.
In my clinical experience, SEEING the tube pass through the vocal cords is my most trusted indicator. But NEVER rely on just one indicator. The standard of care is to have 3.
TheSecretJoe 4 months ago
me too
vkanhy 6 months ago
I went i get olderi want to be a doctor that works at the hopsital
13aturner1 1 year ago