What would be your best order of intubation (Trauma)? A. OPA, BVM, intubation kit ready, intubate, inflate cuff, auscultate for equal bilateral lung sounds and epigastrium, attach wave-form cap, secure the tube. B. OPA, BVM, intubation kit ready, intubate, inflate cuff, auscultation for equal bilateral lung sounds and epigastrium, secure the tube, attach wave-form cap. C. OPA, BVM, hyperventilate to O2 levels for performing intubation, attach wave-form cap, auscultate, inflate cuff, secure the tube. D. OPA, BVM, auscultate, attach wave-form cap on tube, intubate, inflate cuff secure the device.
Ok, it’s actually D. While yours is definitely not far off, you would want to auscultate before you insert an endotracheal tube while someone is giving ventilation with a BVM. What if the pt has a pneumothorax on the left from a gun shot wound and is now intubated. You would then hear absent lung sounds on the left, making you second-guess that you inserted the ETT too far and not realizing that this is potentially a result of the tension pneumo. The wave-form capnography is considered the best tool to utilitize after direct visualization. It would be another confirmation that you are in the trachea. And it takes 10 seconds to put on. Or even put it on prior to live intubation (keeping the tube sterile, of course). Then you can auscultate or ask someone to as a third means of confirming that the tube is in. And if you used a gum-elastic bougie and felt tactile “clicks” and felt push-back, then the ETT is most definitely in the pt’s trachea. Chest x-ray would not be as helpful as esophagus is directly behind the trachea.
