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A patient arrives by ambulance following cardiac arrest. There has been return of spontaneous circulation in the ambulance. Supraglottic airway is in but end tidal CO2 gives no reading. What do you do about the airway?
Ed V., M.D. - August 2, 2015 2:47 AM
Interested in the comment that you'll get a flat waveform capnography trace if the ETT is in the trachea but the patient doesn't have a pulse - I'm not sure that's totally true.
Even if the patient is in full cardio-respiratory arrest, the EtCO2 capnograph usually still demonstrates a waveform if the ETT is in the trachea (albeit with a lower actual numerical reading). You won't get a completely flat trace unless the patient has been in cardiac arrest for a reasonably prolonged period.
So, even if there was no palpable pulse and the patient had gone back into cardiac arrest, if my capnograph trace was flat then I'd still be very concerned the ETT was in the wrong place as I'd still be expecting to see some sort of waveform activity if the ETT was correctly sited.
(Heres one interesting reference about ventilating cadavers:
Emerg Med J. 2015 Mar;32(3):232-3. Sustained life-like waveform capnography after human cadaveric tracheal intubation.)