After endotracheal intubation, which sequence correctly verifies tube placement?

• A. Attach CO2 detector; observe chest rise; auscultate over epigastrum and bilaterally; after 5-6 breaths observe CO2; assess skin color.
• B. Visualize the tube with laryngoscope only and rely on chest movement.
• C. Ventilate with bag-valve mask and forgo auscultation.
• D. Immediately document placement without verification.

Answer: (A)

Verifying placement uses multiple checks, with capnography/CO2 evidence as the most reliable indicator that the tube is in the trachea. Attach a CO2 detector right away; the presence of end-tidal CO2 confirms ventilation through the tube and argues against esophageal placement. Then look for chest rise as a supportive sign that air is entering the lungs, but don’t rely on this alone since chest movement can occur in other situations. Next, listen with a stethoscope to both lungs and to the epigastric region to ensure breath sounds are bilateral and absent in the epigastrium, which helps rule out stomach intubation. After about 5–6 breaths, reassess with the CO2 detector or capnography to confirm a persistent CO2 signal, reinforcing correct placement. Finally, don’t document the tube as placed until these verifications are complete. This sequence combines the most objective measure (CO2) with clinical checks (chest movement and auscultation) to reliably verify tracheal placement.