Quote:
Originally posted by ccrn
QUOTE]Originally posted by greg c
NSTEMI- that's why he was going for an AM cath.
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I always rely on chest rise and auscultation to comfirm ETT (or other) placement. CO2 det are very nice but not gold standard. CXR is even better but of course not available prehospital-
ccrn [/QUOTE]
The gold standard in 2004 IS CO2 detectors or capnography. End tidal CO2 detection comes close to 100% sensitivity and specificity in the patient with spontaneous circulation. Obviously all bets are off in a patient in circulatory arrest as very little CO2 is around to be detected. This is the method recommended by both the American Society of Anesthesiologists and National Association of EMS Physicians.
Esophageal detection devices are easily used but have a higher false negative and false positive rate to make the questionable for use in my opinion.
As for classic physical exam findings... in studies with dogs about 85% of dogs with esophageal intubations had fogging of the tube (don't think they'd let you purposefully do this in humans) and in other randomized prospective studies done in the OR (ie. controlled environment) there was a 15% -25% ERROR rate on auscultating bilaterally in asleep patients where anesthesiologists "heard" bilateral breath sounds in patients with esophageal intubations... all picked up by capnography.
Again...the gold standard is CO2 detection NOT auscultation or fogging.
doc t.