Tracheal tube misplacement in the thoracic cavity: A case report

BACKGROUND: Penetrating neck injuries require prompt recognition, diagnosis and management of critical airways. This case demonstrates an emergent situation that a “medical negligence” was avoided with the aid of end-tidal carbon dioxide (ETCO(2)) waveform. CASE SUMMARY: We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma, resulting in pneumothorax. Tube placement was not confirmed during emergency airway management, and the patient was directly transferred to the emergency operation room. Assisted by ETCO(2) and imaging examinations, the anesthetist timely noticed the absence of ETCO(2) waveform and resolved this urgent situation before anesthesia induction. CONCLUSION: This case emphasizes the necessity of ETCO(2) waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.