As tube drops into the posterior pharynx listen for respiratory sounds. Respiratory sounds are loudest when tube is proximal to the epiglottis. Gently but swiftly advance the tube 3 to 5 cm during peak inspiration. Entrance into the larynx may initiate a slight cough, and most expired air should exit through the tube even though the cuff is uninflated. Breath condensation should intermittently fog the tube.
Most upright patients tolerate intubation in that position.
Voluntary tongue extrusion is helpful in cooperative patients. In less responsive patients, the tongue may be wrapped with gauze and pulled forward. Advancement toward the carina may be observed externally. Suction secretions or blood from the tube prior to positive pressure ventilation. Look for the rise and fall of the chest and listen for breath sounds.