GLOTTIC POSITIONING OF THE ENDOTRACHEAL-TUBE TIP - A DIAGNOSTIC DILEMMA

Dietal placement of the endotracheal tube tip in the glottic opening i s rarely discussed in most emergency medicine, surgery, and prehospita l medicine texts. We report three cases of glottic intubation recogniz ed after the patients were thought to have been successfully intubated . Glottic positioning of the endotracheal tube tip went unrecognized i nitially because of the absence of air heard over the epigastrium, the presence of bilateral breath sounds, and acceptable readings by both pulse oximetry and capnography. Recognition of this complication is ai ded by the use of radiographic findings, inappropriate endotracheal tu be depth, and the presence of inadequate ventilatory volumes. Potentia l complications of glottic intubation include dislodgement of the endo tracheal tube, kinking of the tube, and inadequate protection of the a irway.