Peter Antevy discusses EtCO2 monitoring in pediatric drowning resuscitation. Readings may be absent for 45 seconds to a minute after airway placement, especially after prolonged submersion, because water floods the lungs. Adult filter lines create too much dead space; use pediatric lines for kids under 5.0 tube size or age 2 and younger.
Questions this video answers
About 45 seconds to 1 minute.
Over about 5–6 minutes of downtime.
Anything below a 5.0 endotracheal tube (e.g., 4.5).
Age 2 years or younger → use pediatric/infant filter line.
Chapters
The next topic I want to talk about is an end tidal monitor. The end Tidal CO2 monitor when you have a child who just came out of the pool. So we've had a couple of cases where we have the BVM or we have the eye gel or even an endotracheal tube inside the lung, and we're not getting any end Tidal CO2 reading for about, let's say 45 seconds to a minute. And so there's some physiology that we need to consider here. Again, if you have a child who's got a downtime of, let's say over five to six minutes, their vocal cords have opened and now water is flooding into the lung. And now you get there and you're trying to understand why you're not getting any end tidal back. Well, give it about 45 seconds to a minute before you just give up and say, hey, this tube or this eye gel is in the wrong spot.
Yeah. And I think that if we use our equipment to our advantage, it might be able to help us out. Let's just say a two year old that unfortunately fell in the pool and you used a big and tidal CO2 adult filter line on the end of your circuit, such as your eye gel. What you'll find is a lot of dead space in that filter line. And what you do by using the collapsible spring, it allows that to actually compress down onto the Igel and it doesn't allow so much dead space to fill into the filter line. And, and this actually, if you look where it pulls it into the machine, it's actually much lower down on the tube. So basically what happens with that is that monitor is constantly pulling a sample into it and it doesn't have to clear or go up higher into the circuit to actually pull the reading. So make sure that you, number one, get your eye gel in quickly and then number two, just understand that there might be a little bit of a delay. And another thing to consider is, is if you're actually doing defibrillation during your cardiac arrest. So let's just say you pull the kid out, the kid's 4 or 5 years old, whatever that age may be, and you charge the monitor and you shock the monitor at the same time. You're looking at entitled CO2 with a physio control product or the Stryker product. It uses the same source that it pulls for the defibrillation as it does to pull into the monitor. So give it a few seconds to acclimate to what you're doing and Then if all else fails and you can't get the reading, your tube's no good. You have to withdraw the tube.
And as far as the size of that end tidal filter line, you want to talk about the sizing of that and which tubes and what age trial that can go into.
So the recommendation from the manufacturer of the end tidal CO2 filter line really goes by endotracheal tube size. And what I mean by that is they're telling us that anything below a 5.0 tube, so let's just use for an example, a 4.5 endotracheal tube and you would use the pediatric or infant filter line. So let me summarize it. Let's go solely by age. So if you run a cardiac arrest or you run a patient that needs to be intubated, that's the age of 2 or younger, you're going to be using your small, your pediatric infant end tidal CO2 filter line. Now we're going to make this adjustment in Dr. Antevi's app so it's clear for everyone to see that two and under that age, two and under, you're going to be using the pediatric filter line.
