Right mainstem intubation – CXR

Table of Contents

Table of Contents

Published February 2021

Samantha King, MD
Daniel Gergen, MD
Expert review – pending

Objective(s)

  1. Identify an endotracheal tube on CXR and determine whether it is in the appropriate position

Teaching Instructions

Plan to spend 5-10 minutes familiarizing yourself with the animations of the PowerPoint and the key findings of this chest x-ray.

Present the image either by expanding the window (bottom right) in a browser or downloading the PowerPoint file (downloading is recommended).  Have the image pulled up in presenter mode before learners look at the screen to avoid revealing the diagnosis.  Ask a learner to provide an overall interpretation.  Then advance through the animations to prompt learners with key questions and reveal the findings, diagnosis, and teaching points.

Instructions: Ask a leaner to provide an overall interpretation.  Advance using the arrows or scroll wheel on the mouse reveal subsequent questions with answers and graphics.  You can go back to prior graphics and questions by using the back arrow or scrolling back on the mouse wheel. 

Official CXR Read: Right IJ line terminates in the distal SVC. Enteric tube reaches the proximal stomach. ET tube is been placed and extends approximately 1.7 cm into the right mainstem bronchus. Diffuse lung opacities more focal right basal consolidation. There are is a small right pleural effusion..

Diagnosis: Acute respiratory distress syndrome secondary to sepsis from spontaneous bacterial peritonitis

Teaching: An endotracheal tube should terminate 2-4 cm above the carina. The tube must be low enough to ensure that the cuff will inflate below the vocal cords (avoid vocal cord trauma), and high enough to adequately ventilate both lungs.

Presentation Board

Take Home Points

  1. An endotracheal tube should terminate 2-4 cm above the carina.

References

Godoy MCB, et al. Chest Radiography in the ICU: Part 1, Evaluation of the Airway, Enteric, and Pleural Tubes. Am J Roetgenology. 2012. 198:3, 563-571. 

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