Which finding would be least consistent with mainstem intubation after endotracheal intubation?

Which finding would be least consistent with mainstem intubation after endotracheal intubation?

• A. Unilateral decreased breath sounds
• B. Irregular chest expansion
• C. Elevated peak inspiratory pressure with asymmetric chest movement
• D. Symmetric chest movement

Answer: (D)

Main concept: when the endotracheal tube advances into a mainstem bronchus, ventilation is directed to a single lung, producing asymmetric findings rather than a symmetric pattern. You would expect unilateral diminished or absent breath sounds on the non-ventilated side and unequal chest expansion, with the ventilated side moving more. Peak inspiratory pressure may rise because delivering the same tidal volume through a single, less compliant lung is harder for the ventilator. Symmetric chest movement would not fit this pattern, since the chest rise would be unequal due to one lung receiving air and the other not.

Main concept: when the endotracheal tube advances into a mainstem bronchus, ventilation is directed to a single lung, producing asymmetric findings rather than a symmetric pattern. You would expect unilateral diminished or absent breath sounds on the non-ventilated side and unequal chest expansion, with the ventilated side moving more. Peak inspiratory pressure may rise because delivering the same tidal volume through a single, less compliant lung is harder for the ventilator. Symmetric chest movement would not fit this pattern, since the chest rise would be unequal due to one lung receiving air and the other not.