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Critical Care Mailbag – Intubation Post ROSC

Scott Weingart, MD
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15:03
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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01:33

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EM:RAP 2015 August Summary 1 MB - PDF

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?

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Ed V., M.D. -

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.)

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Quality Review Gets Septic Full episode audio for MD edition 252:40 min - 352 MB - M4AEM:RAP 2015 Août Résumé en Francais Français 62:21 min - 57 MB - MP3EM:RAP 2015 August Canadian Edition Canadian 31:42 min - 29 MB - MP3EM:RAP 2015 August Aussie Edition Australian 58:17 min - 53 MB - MP3EM:RAP 2015 Agosto Resumen Español Español 76:59 min - 71 MB - MP3EM:RAP 2015 August MP3 306 MB - ZIPEM:RAP 2015 August Summary 1 MB - PDFEM:RAP Español Agosto 2015 2 MB - PDFEM:RAP 2015 August Board Review Questions 223 KB - PDFEM:RAP 2015 August Board Review Answers 239 KB - PDF

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