Before intubation
- Use waveform capnography before the attempt when possible so the team expects confirmation immediately.
- Assign someone to call out EtCO2 waveform and value.
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Post-intubation rescue
No EtCO2 Waveform After Intubation
No waveform EtCO2 after intubation is a crisis until proven otherwise. Assume the tube or the circulation is the problem and act immediately.
EtCO2confirmationDOPEStube placement
Clinical-use limit: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment.
During intubation
- If no waveform: stop, oxygenate, reassess tube position, patient perfusion, and equipment.
- Do not anchor on visualized tube passage if waveform is absent.
- Use direct visualization, depth, chest rise, gastric sounds, ultrasound/CXR as adjuncts, but waveform and clinical context remain central.
After intubation
- If displaced, remove/reintubate/oxygenate per rescue plan.
- If low-flow arrest, continue resuscitation and interpret EtCO2 accordingly.
- Document confirmation method.
Common pitfalls
- Ignoring no waveform because “I saw it pass.”
- Not checking monitor/circuit connections.
- Delayed extubation of an esophageal tube.