A search for proper positioning of all life-support apparatus should be a requisite part of the assessment of all chest radiographs. Proper positioning of the endotracheal tube within the trachea and approximately 5 cm from the carina should be confirmed with routine postintubation radiographs ( Henschke et al: 1996) (Fig.,,,
5). The cuff of the endotracheal tube should also be observed for overdistention, as evidenced by bulging instead of parallel walls. The tip of the tracheostomy tube should lie between half and two-thirds of the distance between the stoma and the carina. Chest radiographs should be obtained immediately after tracheostomy tube placement to search for complications such as malpositioning, pneumothorax, pneumomediastinum, or atelectasis from aspirated mucus or blood clot ( Henschke et al.
Fig. 5 Inadvertent esophageal intubation. This patient had been unsuccessfully resuscitated elsewhere for over 2 h. Notice that the stomach is distended with gas and that the endotracheal tube (arrows) is located to the left of the tracheal air column in the esophagus. (Reproduced with permission from Worrelj.,,, ,(.1,994.).)
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