Intubation q...... - drdimaria

[ArchivalUser]

For confirming endotracheal tube placement
following intubation of a patient in cardiac arrest,
which ONE of the following methods is the most
reliable?
A. Waveform capnography
B. Calorimetric end-tidal carbon dioxide (ETCO2)
C. Oesophageal detector device
D. Pulse oximetry

Pls answer with explanations only.....

[ArchivalUser]

A.Waveform capno-graphy is the most reliable and accurate.This is because depending on good pulmonary alveolar venous perfusion the CO2 level in expired air can be quantified graphically once there is ROSC(Return of Spontaneous Circulation) after cardiac arrest.

Less than 15mm Hg pCO2 is indicative of hypotensive shock or patient still in cardiac arrest. Whereas, sharp rise in wave form to more that 25 - 40 mm Hg confirms return of circulation after successful CPR.

The others are not reliable:
B. Colorimetric ETCO2 just changes the pH color from Pink to Golden, when it's in contact with CO2 in expired air confirming intubation initially( does't confirm tube block or displacements). But if the tube is in esophagus CO2 trapped there in facial trauma or head injury, and even regurgitated acid from stomach can give false positive result for positive intubation.


The other two C & D : are not reliable for same reasons as above.

[ArchivalUser]

Hi drdimaria and eireman.
The correct answer from the choices is B.
Because continuos detecting of carbon-dioxide is needed to be sure that ETT is in the correct position.
thanks

[ArchivalUser]

The correct answer is A.............

though ETCO2 is considered the most reliable method to confirm ET placement...........in certain subset of patients like this one with CARDIAC ARREST.........due to dec pul blood flow insufficient co2 is exhaled................IN such patients.......WAVEFORM CAPNOGRAPHY was found to be 100% sensitive and 100% specific...........