Acute management of the obstructed endotracheal tube.

For acute respiratory distress or arrest, endotracheal intubation is a life-saving procedure in emergency airway management. There are many possible complications that may present with manipulation of the airway. This case will discuss factors that one may consider when adequate oxygenation or ventilation is not achieved after an endotracheal tube (ETT) is placed. Issues that can lead to difficulty in ventilation should be rapidly identified and reversed if respiratory acidosis, hypoxemia, and respiratory arrest are to be avoided. These include causes of air trapping, such as asthma or foreign body aspiration; ETT obstruction due to biting, tube kinking, or mucus plugging; and external lung compression from pneumothorax, hemothorax, or diaphragm rupture.