While performing cardiopulmonary resuscitation, the therapist is ...

[naturalchemist]

While performing cardiopulmonary resuscitation, the therapist is attempting to orally intubate the patient. The therapist observes the distal tip of the ET tube pass through the glottis. After attaching a colorimetric CO2 detector to the ET tube, the therapist notices that the face of the CO2 detector appears yellow. What should the therapist do at this time?
 
  A. Obtain a different colorimetric CO2 detector.
  B. Remove the ET tube, and reintubate the patient.
  C. Secure the ET tube in place with adhesive tape.
  D. Wait until the paper on the colorimetric CO2 detector turns purple.

Question 2

The therapist is providing volume controlled-continuous mandatory ventilation (VC-CMV) to a patient using the following settings: PIP 40 cm H2O Pplateau 25 cm H2O PEEP 10 cm H2O VT 700 ml Tubing compliance factor 3 ml/cm H2O Based on this information, calculate the volume compressed in the ventilator breathing circuit at the end of inspiration.
 
  A. 120 ml
  B. 90 ml
  C. 75 ml
  D. 45 ml

[kescobar@64]

Answer to Question 1

ANS: C
A. Incorrect response: During this resuscitation effort, the fact that the colorimetric CO2 detector indicates yellow means that CO2 is being exhaled. Also, consider the fact that the therapist observed the distal tip of the ET tube pass through the glottis. The CO2 detector is working properly since the pH-sensitive paper changed from purple to yellow.
B. Incorrect response: Removing the ET tube, and attempting to reintubate the patient are common errors in this situation. Again, the therapist saw the distal tip of the ET tube enter the trachea. Measures need to be taken to verify ET tube location. The colorimetric CO2 detector is working properly because the pH-sensitive paper changed color from purple to yellow.
C. Correct response: Because the therapist saw the distal tip of the ET enter the trachea, the therapist should secure the ET tube in place, and proceed with performing other assessments for proper ET tube placement. For example, the therapist should auscultate for bilateral breath sounds over the patient's thorax, listen for air movement or gurgling sounds over the epigastrium, observe for even movement of the chest wall. Ultimately, a portable chest x-ray needs to be obtained to confirm proper ET tube placement. Observing the colorimetric CO2 detector remain purple indicates the patient is likely having a cardiac arrest. With no blood being transported to the lungs, little (if any) CO2 is diffusing into the alveoli. Therefore, no CO2 is available to change the pH-sensitive paper from purple to yellow.
D. Incorrect response: In the presence of CO2 the colorimetric analyzer will change from purple to yellow. The detector will not turn back to purple. When the colorimetric device remains yellow, a lack of blood flow is indicated, and CPR must be resumed.

Answer to Question 2

ANS: B
A. Incorrect response: See explanation B.
B. Correct response: When the tubing compliance (CT) is known, the formula for calculating the compressible volume is as follows:
(PIP  PEEP) CT = Vcompressed
(40 cm H2O  10 cm H2O) 3 ml/cm H2O = 90 ml
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.

[naturalchemist]

Gracias!

[miss_1456@hotmail.com]

Thanks for the timely response, appreciate it