Post-Intubation Care Basics

Why This Is Hard

Teams celebrate the tube and then lose it in packaging, hyperventilate the patient into hypotension, or miss esophageal placement because confirmation was a single glance. Post-intubation care is half the airway job.

Immediate Checklist (Education)

1. Confirm — continuous waveform EtCO₂, bilateral sounds, chest rise; fix DOPE problems immediately.
2. Secure — commercial tube holder or equivalent per training; note depth at the teeth/gums.
3. Ventilate with discipline — avoid hyperventilation; match rate/volume to protocol and pathology.
4. Oxygenate — appropriate FiO₂ strategy; watch SpO₂ trend with probe that actually works.
5. Hemodynamics — positive pressure can drop BP; be ready per protocol (fluids/pressors only if authorized).
6. Sedation/analgesia awareness — if your system continues sedation, know indications and monitoring; do not freestyle.
7. Reconfirm after every move — stretcher, ambulance, hospital bay.

Key Points for Paramedics

• Depth migration is common — document cm marking and recheck.
• Mainstem intubation presents as unilateral sounds and poor compliance — pull back carefully per training.
• EtCO₂ sudden loss = emergency until proven otherwise (displacement, arrest, disconnect).
• Gastric tube / NG-OG only if protocol and training support it for aspiration risk reduction.

Field Pitfalls

• No continuous EtCO₂ after “color change once.”
• Taping loosely then rolling the patient.
• Bagging like an ACLS mega-code on a pulse-present medical patient.

Practice

Run a 60-second post-tube callout: confirm → secure → rate → BP → recheck after move. Related: DOPE-S.

Sources & Further Study

• Airway and post-intubation protocols; AHA ventilation education concepts.