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Troubleshooting review

No or low EtCO₂ waveform

No waveform is a crisis until proven otherwise.

Educational review boundary: This page summarizes common patterns and published management options. It does not analyze an individual patient or generate a treatment directive. Verify the current source, local protocol, and clinical context.
Tube problemEsophageal, mainstem, dislodged, obstructed.Equipment problemCapnography, sampling line, circuit, monitor.Low-flow stateArrest, severe shock, very low perfusion.

Management considerations

  • Assume tube/circulation/equipment problem until proven otherwise.
  • Reconfirm tube with direct visualization if needed.
  • Check capnography connection, circuit, and monitor.
  • If in arrest/low-flow state, interpret EtCO₂ in resuscitation context.

Clinical review / use limits

Authored by: Airway of the Month education team. Last reviewed: July 2026. Audience: EM learners, faculty, EMS, RT, simulation educators, and airway teams.

Resources · Editorial policy · ACEP intubation policy · AARC 2024 ventilator assessment guideline · ATS 2024 ARDS guideline update

About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]