How should you immediately confirm ETT placement?

• A. Continuous waveform capnography, bilateral breath sounds, symmetrical chest rise, and absence of significant gastric distension.
• B. Lack of breath sounds and asymmetric chest rise.
• C. Only auscultation of breath sounds.
• D. Capnography trace is absent but chest rise is present.

Answer: (A)

Immediate confirmation of ETT placement hinges on proving the tube is in the trachea, not the esophagus. The most reliable first step is continuous waveform capnography; a persistent, normal end-tidal CO2 tracing confirms airway placement and ongoing ventilation. Clinical signs serve as helpful checks, with bilateral breath sounds and symmetric chest rise supporting correct tube position, and the absence of significant gastric distension arguing against esophageal intubation. Relying on auscultation alone or on chest movement without capnography can be misleading, because sounds and movement may occur even with incorrect placement or poor ventilation.