Performing laryngoscopy on every patient intubated in the field exposes most of these patients to unnecessary risks. First, you will likely need to re-paralyze a lot of patients unnecessarily, and it’s actually not a particularly accurate way to confirm ETT placement since many will have lots of debris in the glottic region that may confound your view. As expert airway practitioners, we should be advocating for continuous wave form capnography as a standard of care in the overwhelming majority of emergency departments in the country. It is very effective at confirming ETT placement and monitoring your patient for badness during their peri-intubation course.
If you suspect a problem with your tube, a far safer and more effective means than laryngoscopy to confirm tube placement is to simply pass a bronchoscope down the tube to visualize the carina. This is both diagnostic and therapeutic if the tube or bronchus is obstructed with mucus, misplaced, etc. Bronchoscopy is a billable procedure, remarkably fast to do, and does not require a patient be paralyzed for a quick look.
For what it’s worth, I’m called to the bedside weekly to evaluate problems with ET tubes - mostly cuff leaks, suspected mucus plugging, etc. My first step is to always visually inspect the tube’s position, patency, and compliance on the vent. Then, hook up capnography if not already done and the tube to a BVM. If anything seems odd while bagging, make sure your airway cart and drugs are is in the room, and then take a look with a bronchoscope. Never try to blindly advance or inflate cuffs on tubes that are misbehaving.
