A 6-year-old child who has just been intubated shows bilateral breath sounds that are louder on the right with decreased chest movement on the left. The most appropriate action is to

• A. Insert a chest tube into the right thorax
• B. Remove the tube and re-intubate
• C. Withdraw the tube a few centimeters and reassess breath sounds
• D. Request a right lateral chest X-ray

Answer: (C)

Unilateral misplacement of the endotracheal tube is being tested here. When the tube goes too far, it often enters the right mainstem bronchus in children, leading to predominant ventilation of the right lung with reduced expansion of the left. The safest and fastest fix is to gently withdraw the tube a few centimeters and then reassess breath sounds and chest movement. If bilateral breath sounds become equal and chest expansion improves, ventilation is corrected. After adjusting, confirm tube position with auscultation and consider a chest X-ray for documentation. A chest tube isn’t indicated without signs of a pneumothorax, and reintubation isn’t needed if repositioning resolves the issue.