dimps
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You are present during the intubation of an 87-year-old man who was found unconscious by his nurse.
The patient was admitted to the hospital that morning after a syncopal episode. He has a past medical
history of coronary artery disease and is status-post a Q-wave myocardial infarction and a 3-vessel
bypass procedure 7 months ago. This morning, he had a syncopal episode that was preceded by
palpitations and chest pressure. About 10 minutes ago, his nurse heard a fall and came to the room to
find the patient on the floor, pulseless and apneic. A senior medicine attending places the
endotracheal tube via direct laryngoscopy. The most sensitive method for the detection of an
appropriately placed tube is
A. absence of air heard in the stomach
B. bilateral breath sounds
C. detection of end-tidal carbon dioxide
D. restoration of 100% saturation by pulse oximetry
E. rise and fall of the chest with positive pressure respirations
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| meg
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C
end tidal Carbon dioxide is most sensitive, there are disposable Co2 detector strips available.
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| dimps
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meg u r right ...also try this
You are called to intubate a patient on the surgical floor. The patient is postoperative day number 2 after a lumbar disc removal for sciatica. She had an uneventful postoperative course but has a past medical history significant for severe ischemic congestive heart failure. Four hours ago, she began to complain of shortness of breath and has progressively worsened despite diuretic therapy and supplemental oxygen. On arrival to the bedside, her temperature is 37.0 C (98.6 F), blood pressure is 170/105 mm Hg, pulse is 102/min, and respirations are 38/min. Oxygen saturation is 82% on 100% nonrebreathing mask. The patient is somnolent and minimally responsive. After laryngoscopy and insertion of the endotracheal tube, the next most appropriate step is to
A. auscultate for air in the stomach
B. auscultate for breath sounds
C. check for end-tidal carbon dioxide
D. deliver 100% inspired oxygen and initiate mechanical ventilation
E. inflate the balloon on the endotracheal tube
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| usmleasr
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A?...in wards we check like this to see if it is placed wrongly 
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| meg
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I agree about A. That is the first step, if we dont hear airflow in the stomach and/or no distension of stomach, then we listen to b/l chest to make sure we are in trachea and not right bronchus. Then after securing the tube with tape etc, take an xray and ABG.
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| dimps
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the answer is e....now try this one.
A 29-year-old man is brought to the emergency department because of a severe asthma attack. Two hours ago, he began to wheeze and it has progressively worsened to the point where he is unable to move air. He has suffered from asthma since the age of 7 and has been hospitalized multiple times for asthma flares. His home medications include albuterol MDI, ipratropium bromide MDI, inhaled steroids, and oral theophylline. His temperature is 37.0 (98.6 F), blood pressure is 185/105 mm Hg, pulse is 90/min, and respirations are 90/min. Arterial blood gas on 100% oxygen is PaO2 56 mm Hg, PaCO2 48 mm Hg, pH 7.26. The decision is made to intubate the patient. After laryngoscopy, intubation, cuff inflation, and end-tidal carbon dioxide confirmation, the next step in confirming placement of the tube is to
A. auscultate for breath soun
B. auscultate the stomach
C. ask the patient to speak
D. get a chest radiograph
E. none is required, the tube is appropriately placed
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| meg
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auscultate stomach
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| blrgirl
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could it be chest xray. since we already have confirmed it with end tidal co2 y auscultate stomach. and stomach auscultation is done initially soon after intubation even b4 securing the tube.
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| dimps
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answer is A
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