An Emergency Medical Squad (EMS) may attempt to intubate a patient prior to reaching the hospital. Sometimes there is failure to intubate the trachea, with potentially fatal consequences.
A misplaced endotracheal tube may enter the esophagus (with insufflation of the stomach) or may be proximal to the epiglottis. Insufficient air may reach the lungs, suffocating the patient.
Risk factors for a misplaced endotracheal tube:
(1) failure to train adequately
(2) failure to maintain competency
(3) difficult intubation
(4) failure to monitor after intubation (capnography with end-tidal CO2)
(5) failure to monitor during transport
Prevention:
(1) adequate initial and ongoing training
(2) use of a laryngeal mask airway or similar device
(3) strict protocols
The possibility of intubation tube misplacements highlights the need to leave all tubes in place so that they can be evaluated at autopsy.
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