Pearl # 5: Preattach ETCO2 Filter to ET Tube

When intubating preattach the ETCO2 to the tube.  If you have a narrow stylet, this is possible.  Attach the ETCO2 to the monitor.  If I have trouble seeing the chords, I hand the tube to my assistant, then using my right hand apply crick pressure until I can see the chords, then I have my assistant replace his fingers where mine were, and I pass the tube.  Once the tube is passed, I look at the monitor.  If CPR is being done, this is what I will see.

The CPR is creating passive ventilation that registers on the monitor.  Once the ambu-bag is attached and the first ventilation given, the cpr wave form is replaced with the traditional form. 

Instead if you just see flat line (with CPR) you may not be in.

Unless you are certain the tube is good, don’t bother with checking belly and lung sounds just take it out and try again or insert a supraglottic airway.

Stay Tuned for cardiac arrest PEARL # 6  Use ETCO2 to Ensure CPR Quality

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