Step 4
Post-Airway
Confirm the tube, secure it, set the ventilator, start analgesia/sedation, and complete follow-up.
Checklist
0 of 9 complete
Tube confirmation
Continuous waveform capnography is the primary confirmation and ongoing displacement monitor when a perfusing rhythm is present.
Team prompt: Waveform is ___. Tube depth is ___. Reconfirmation trigger is ___.
Review the options and verify against current local protocols.
Secure
Tube security is a continuing process, especially during transport and repositioning.
Team prompt: Depth is __ at __. Securement is __. Circuit is supported by ___.
Review the options and verify against current local protocols.
Gastric-tube placement is not automatic; use it when decompression, medication delivery, feeding planning, or reduced gastric insufflation is clinically useful.
Team prompt: Gastric tube is indicated for ___. Route is ___. Verification method is ___.
Review the options and verify against current local protocols.
Ventilation
Initial settings are a starting point; the required plan differs for ARDS/shunt, obstructive disease, severe acidosis, and normal lungs.
Team prompt: Mode is ___. VT is ___. RR is ___. PEEP/FiO₂ is ___. Reassessment is at ___.
Review the options and verify against current local protocols.
Sedation / analgesia
Neuromuscular blockade provides neither analgesia nor amnesia.
Team prompt: Analgesic is ___. Bolus is ___. Maintenance is ___. Reassessment sign is ___.
Review the options and verify against current local protocols.
Use an explicit target and ensure the plan covers the full duration of paralysis.
Team prompt: Sedative is ___. Target is ___. Bolus/infusion is ___. Reassessment is ___.
Review the options and verify against current local protocols.
Post-intubation deterioration is often recognizable before the full diagnosis is known.
Team prompt: Current failure signal is ___. Immediate action is ___. Working bucket is ___.
Review the options and verify against current local protocols.
Follow-up
The value is useful only when timing and the clinical question are clear.
Team prompt: The gas question is ___. If PaCO₂/pH is __, we will change ___.
Review the options and verify against current local protocols.
Chest radiography does not replace continuous waveform capnography for initial tube confirmation.
Team prompt: Imaging indication is ___. Immediate concern that cannot wait is ___.
Review the options and verify against current local protocols.
Key points
- The airway is not complete at tube passage. Immediate confirmation, analgesia/sedation, ventilator setup, hemodynamic reassessment, and follow-up prevent avoidable post-intubation harm.
- Team prompt: The ETT is confirmed with continuous waveform capnography and secured. OG/NG placement is addressed. Vent settings are verbalized and confirmed. Analgesia and sedation are active. Hemodynamics and oxygenation are reassessed. Blood gas and chest imaging will be obtained when indicated.
Common pitfalls
- Relying on auscultation without waveform capnography
- Leaving a paralyzed patient without analgesia and sedation
- Vent settings not verbalized or reassessed
- Post-intubation hypotension or hypoxia ignored
- Treating blood gas or chest X-ray as automatic rather than indication- and context-dependent follow-up