with modern day CO2 detectors, listening isnt even necessary. And if you have a pulse oximeter, which most EMS should, there is no excuse for not recognizing esophageal intubation. But my main point was that I do not think RSI or use of paralytics is a field procedure for EMS. Period.
We will just have to agree to disagree. This is an issue where informed people of good will could disagree.
Hello again, Mom MD. I wish to respectfully weigh in on the subject of capnometry, if I may.
Current ACLS/TNCC guidelines call for a rapid, three-step methodology for verifying proper ETT placement. First is auscultation at the epigastum for gurgling; second is auscultation at bilateral upper chest at mid-clavicular lines for air movement; third is observation of the CO2 detector for yellow vs. purple.
It may seem redundant, but I have personally caught esophageal intubation in this manner at step one before the capnometer turned purple. It may seem time-consuming at first, but in this case it saved a few seconds. And in a crash, a few seconds can make the difference.
However, I do agree that the capnometer is a valuable tool for verification of ETT placement.
Thank you for your kind indulgence. Have a blessed Sunday!
/Gunner
(late to this discussion) Authors who are paid to criticize certain medical procedures/events get less attention from me(PI attys, expert witness). That said, in 35 years and hundreds of intubations, I have never overlooked tube placement. I can not imagine the scenario in which this can happen. Tube is in when I see it go in, no guessing. Listen w/scope, no guessing. CO2/oximeter tools of course(didn’t exist in my early years). Well secured by method of my choice, not the latest gizmo. Then monitoring every second. No guessing. Have a plan for unproven tube placement. If one is expected to perform these procedures, one must know for certain their skill set. If uncertain, retrain or retire. Add: I pray for tort reform in this country, and wish a pox on the personal injury clan. I have so enjoyed my couple of times on the stand, chewing up absurd allegations/expectations.