Scribd
Upload
200 views36 pages

A Powerful Tool To Objectively Monitor Your Patients Ventilatory Status

Capnography is a tool that objectively monitors a patient's ventilatory status by measuring exhaled carbon dioxide (CO2). It provides important information about ventilation by analyzing the capnogram waveform and measuring end-tidal CO2 (EtCO2) levels. Normal EtCO2 is 33-42 mmHg. Capnography can confirm endotracheal tube placement, monitor tube position during transport, assess CPR effectiveness, and detect return of spontaneous circulation. It also helps evaluate non-intubated patients with conditions affecting breathing such as asthma, shock, or drug overdoses.

Uploaded by

Beth Strom-Sturm
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
200 views36 pages

A Powerful Tool To Objectively Monitor Your Patients Ventilatory Status

Capnography is a tool that objectively monitors a patient's ventilatory status by measuring exhaled carbon dioxide (CO2). It provides important information about ventilation by analyzing the capnogram waveform and measuring end-tidal CO2 (EtCO2) levels. Normal EtCO2 is 33-42 mmHg. Capnography can confirm endotracheal tube placement, monitor tube position during transport, assess CPR effectiveness, and detect return of spontaneous circulation. It also helps evaluate non-intubated patients with conditions affecting breathing such as asthma, shock, or drug overdoses.

Uploaded by

Beth Strom-Sturm
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 36

Capnography for EMS

A powerful tool to objectively


monitor your patients ventilatory
status.
Session Objectives

• Define capnography and related terms


• Compare capnography to other monitoring
parameters
• Describe the physiology behind capnography
• Identify a normal capnogram and normal end-
tidal CO2 values
• Identify abnormal waveforms
• List the basic clinical applications in EMS
Terminology: What is End Tidal CO2?

• The non-invasive
measurement of CO2
exhaled at the airway at
the end of a breath
• Normal values are 33-42
mmHg
• (35-45 mmHg)

“capnos” = smoke
Terminology

• Colorimetric
– Disposable
detector
– Litmus paper
– Color changes in
the presence of
CO2
Terminology

• Capnogram
– Graphical tracing
or representation
of exhaled CO2 at
the airway
– Waveform
Terminology

• Capnograph
– Instrument
– Monitor that
provides a
number and a
waveform
• Capnography
Physiology of Carbon Dioxide

• Oxygenation: The process of getting oxygen


into the body and to the tissues for metabolism,
is monitored with pulse oximetry.
• Ventilation: the process of eliminating CO2
from the body, is monitored with capnography.
Physiology of CO2

Oxygen -> lungs -> alveoli ->


Oxygen
blood
breath
CO2 muscles + organs
lungs
Oxygenation
Ventilation Oxygen
CO2
cells
blood energy
Oxygen
+
CO2 Glucose
Physiology of Carbon Dioxide

• Capnography can provide information about the


profusion status.
• Example: Low cardiac output caused by
cardiogenic shock or hypovolemia wont carry as
much CO2 per minute back to the lungs.
ETCO2 will be reduced. Reduced perfusion to
lungs causes this phenomenon.
The Normal Capnogram

A picture is worth a thousand words!


Capnographic Waveform

Zero baseline (A-B) End tidal value (D)


Rapid, sharp rise (B-C) Rapid, sharp downstroke (D-E)
Alveolar plateau (C-D)
Phases of Exhalation

• Beginning exhalation = no CO2 in breath

• Middle exhalation = Rapid rise in CO2

• End exhalation
– CO2 levels continue to gradually rise (alveolar
plateau)
– Peak just before inspiration (EtCO2)
Clinical Applications: Airway

• Verification of endotracheal tube placement


– AHA Guidelines 2000
• confirm ETT placement with non-physical examination
techniques including capnography
• Controlled ventilation for sensitive to fluctuation-
Neonates and Mild Hyperventilation for Head injuries 30
mm.
• Continuous monitoring of endotracheal tube position
during transport (tube vigilance)
• CPR
– Effectiveness of cardiac compression/pacing
– Earliest sign of ROSC
– Predictor of survival- ETCO2 of 10 mm or less at 20
minutes had little chance of survival.
Clinical Applications: Airway

• I KNOW THE TUBE WAS IN BUT….

– Moved to gurney
– Moved to/from ambulance
– Moved to ER
– CPR
– Seizures
– Agitation
REQUIRED FOR ALL INTUBATED/COMBI
TUBE PATIENTS!!
Displaced Intubation

• The ETCO2 will respond much faster to the


displacement.
• ETCO2 is a monitor of ventilation, SPO2 is
oxygenation.

35 mmHg
Non-Intubated Applications

• Bronchospastic Disease

• Hypoventilation States

• Shock States

• The list goes on…


Phases of Acute Asthma Exacerbation

Phase Clinical ETCO2 Levels


Assessment

Mild Hyperventilating <35

Moderate Tiring 40-50

Severe Tired >50


Acute Respiratory Diseases

• Bronchospastic disease (Asthma, COPD)


– Diagnose presence of bronchospasm
– Assess response to treatment
Clinical Applications: Breathing

• Drug overdose
• ETOH overdose Hypoventilation Syndromes
• DKA
• Post ictal
• CVA
• Head trauma
• Neuromuscular
Shock States

• Precipitous drop or downward trending in the EtCO2

• Cardiogenic shock

• Septic shock

• Hemorrhagic shock (trauma)

• Hypovolemic shock
– Heat stroke
Pulmonary Embolism

40 mmHg

• Low EtCO2 with small waveform


• Low SpO2

Pulmonary Hypo-perfusion
What should you do with bagging?
What should you do with bagging?
What’s wrong with this waveform?
What does this indicate on intubated patient?
What’s happening with this non-intubated patient?
Is your bagging OK?
The Gear
The Gear
The Gear
The Gear
The Gear
Summary: Capnography: The Ventilation Vital Sign

• What can capnography monitoring do for you?


– Confirm tube placement during intubation
– Provide tube vigilance during intubation and
transport with alarms
– Identify ROSC during CPR,effective compressions,
outcomes
– NON-INTUBATED
• Monitor breathing status of obtunded/sedated
patients
• Track progression of acute respiratory failure
Summary

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy