Float Nurse

Pediatric PEA Secondary Survey ·          Intubate ·          Oxygenate ·          IV access ·          Treat reversible causes Note: Once the patient is intubated, continue CPR with asynchronous ventilations and chest compressions. Formula for Estimating Endotracheal tube size:  Uncuffed ET tube:  mm ID = (age in years/4) + 4 Cuffed ET tube:  mm ID = (age in years/4) + 3.5 Confirm ET tube placement n   Direct cord visualization n   End-tidal CO2 monitor n   Purple- problem n   Yellow- yes n   Tan- think about it n   Bilateral breath sounds n   CXR n   Continuous waveform capnography Note:  Continuous quantitative waveform capnography is now recommended for intubated patients throughout the periarrest period as a means of bot...

The AHA states that continuous waveform capnography in addition to clinical assessment is the most reliable method of confirming and monitoring correct placement of an endotracheal tube. Under normal conditions PETCO2 range between 35 to 40 mm Hg. During untreated cardiac arrest CO2 continues to be produced in the body, but there is no CO2 delivery to the lungs. Under these conditions PETCO2 will approach zero. However, with initiation of CPR, the cardiac compressions improves the cardiac output and the delivery of CO2 delivery to the lungs. Thus, if ventilation is relatively constant, the PETCO2 values correlate well with cardiac output during CPR. The AHA notes that a persistently low PETCO2 values (<10 mm Hg) during CPR in intubated patients suggest that the return of spontaneous circulation is unlikely. Monitoring PETCO2 trends during CPR has the potential to guide individual optimization of compression depth and rate and to detect fatigue in the provider performing ...