Breath sounds alone are not sufficient, nor is the presence of breath sounds over the epigastrum sufficient reason to pull the tube.
Presence of gurgling over the epigastrum is another story. Actual breath sounds can resonate through the diaphragm to be heard in the stomach, and gastric sounds can be heard vice versa. The best way to confirm tube placement is to use every method at our disposal, with at least one of those methods being waveform capnography.
In this case, a gaggle of physicians even ignored an awful set of arterial blood gases at first, and chose to tweak ventilator settings instead. The chest radiograph eventually told the tale, but even a chest x-ray can be fooled. Remember, the chest radiograph shows the depth of the tube. It may be at the optimum depth on the chest film… but in the esophagus and not the trachea.
One of the biggest lies in EMS is "I swear I saw the tube go through the cords." Think about it: when is it ever necessary to even speak those words, unless the tube has proven to be in the wrong place?
The only self-delusions to rival it in EMS are "Looks like atrial fib" and "I think the triage nurse has the hots for me."