Comment in @AirwavesLive meeting about whether CUSS or PACE is better Graded assertiveness & hierarchy flattening I don’t mind Pick one Use one CUSS I am Concerned I an Unhappy Safety issue You must Stop PACE Probe Alert Concern Emergency @NicholasChrimes @bobfunn

I think if you check the messaging from the authors of the systematic review, it is very clear & very consistent “Clinical signs don’t usefully exclude oesophageal intubation. Capnography (sustained exhaled CO2) does.” That’s it That’s the message @NicholasChrimes @VirtueOfNothing @AndyHiggsGAA

The KEY point here is that the evidence review is not stating “clinical examination is of no value” What it DOES say is “clinical examination is of no value in excluding oesophageal intubation” Further, clinical examination can lead one down a path of misdirection that ends in patient harm The mantra “I’ve got misting & chest rise & now I’m going to look at the capnograph” needs to be replaced by “what does the capnograph show?” Once intubation is confurmed one can worry about endobronchial intubation. Worth noting that with routine VL you also see exactly how far the tube passes the cords & endobronchsil intubation is very rare.