Which indicates an esophageal intubation?

• A. Phonation.
• B. Absence of breath sounds.
• C. Gurgling sounds heard over the epigastrium.
• D. All of the above.

Answer: (D)

When the tube ends up in the esophagus, air isn’t reaching the lungs, so you typically get no breath sounds on auscultation and no reliable chest rise during ventilation. Instead, the air you’re delivering can inflate the stomach, producing distension and gurgling sounds felt or heard over the epigastrium. You may even pick up phonation—the patient’s voice—if air is moving through the upper airway in a way that allows sound to be heard even though the lungs aren’t being ventilated. Taken together, these signs strongly indicate esophageal intubation. In practice, confirm placement with objective checks (like waveform end-tidal CO2), assess bilateral breath sounds and chest movement, and if in doubt, reassess and reattempt tracheal placement.