For approximately 20 years, there has been ongoing research and development to improve upon the basic techniques of physical examination confirmation of ET intubation. Physical examination with auscultation has been found to be inadequately sensitive (94%) and specific (83%) as an independent method for confirmation of correct ET tube placement.3 This chapter discusses the use of physical exam findings, esophageal detection devices (syringe and bulb), carbon dioxide (CO2) detection devices (a qualitative detector and a continuous quantitative monitor), and imaging techniques (radiography and ultrasound). Each method is described for a patient with normal anatomy and the absence of any pathology (e.g., neck or chest trauma). While all these methods can be used in all patients, certain patient conditions or pathology may affect the accuracy of some methods. No single method is universally or completely reliable, obviating the need for a multiple method approach. This multiple method approach to confirmation of ET intubation is now the accepted practice according to The American College of Emergency Physicians (ACEP) Board of Directors policy statement as of April 2009.4