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Presented by: Presented by: Christopher Smith FF/NREMT-P Christopher Smith FF/NREMT-P

Capnography 2

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ETCO2 for EMS

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Page 1: Capnography 2

Presented by:Presented by:Christopher Smith FF/NREMT-PChristopher Smith FF/NREMT-P

Page 2: Capnography 2

Understand the difference between oxygenation and ventilation

Define end-tidal CO2

Understand the difference between waveform and colorimetric monitoring

State what the normal range of EtCO2 is Identify the phases of a normal waveform Recognize normal and abnormal

waveforms of capnography

Page 3: Capnography 2

ETCO2 is the monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases.

EtCO2 assesses ventilation, by measuring carbon dioxide in the exhaled gas

Page 4: Capnography 2

What is the difference?

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Two completely separate functions of life

Oxygenation is the transport of O2 from the bloodstream to the body’s cells Oxygen is required for metabolism

Ventilation is the exhaling of CO2 through the respiratory system Carbon dioxide is a byproduct

of metabolism

Page 6: Capnography 2

OxygenationOxygenation(Pulse-Ox(Pulse-Ox))

CellularCellularMetabolismMetabolism

VentilationVentilation(ETCO2)(ETCO2)

COCO22

OO22

Page 7: Capnography 2

Measured by pulse oximetry (SpO2) Definition - Percentage of oxygen in red blood

cells Non-invasive monitoring Changes in ventilation take several minutes

to be detected Affected by motion artifact, poor perfusion

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Measured by the end-tidal CO2

Definition - Partial pressure (mmHg) or volume of CO2 in the airway at the end of exhalation

Breath-to-breath measurement provides information within seconds

Not affected by motion artifact, poor perfusion

Page 9: Capnography 2

Oxygenation Oxygen for

metabolism SpO2 measures

% of O2 in red blood cells

SPO2 reflects change in oxygenation within up to5 minutes

Ventilation Carbon dioxide

from metabolism EtCO2 measures

exhaled CO2

ETCO2 reflects change in ventilation within 10 seconds

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Why measure ETCO2?

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Pulse oximetry – Over 3-5min to see the decrease in O2 – External and some internal factors

affect the reading Capnography – Breath to Breath – Not affected by external factors

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“Gold standard” for verification of ET tube placement

Immediately detect changes in ET tube position

Earliest indication of ROSC Verification of ETT placement Recognition of specific medical conditions Guide treatment decisions CPR: adequate compressions and possible

survival indicator

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Bronchospasm Asthma COPD Burns, Anaphylaxis, Trauma Hypoventilation Drugs, stroke, CHF, post-ictal Shock Hyperventilation syndrome

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Colorimetric Sensors/Detectors Easy Cap Device is attached to the ET

Tube. Fairly accurate (not for long term use) Litmus paper is worthless when wet Disposable

Page 15: Capnography 2

A qualitative recording of the pt’s ETCO2 reading by use of an illustrated waveform and quantitative numerical value.

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Interpreting EtCO2 Measuring Physiology

Capnography waveform

Page 17: Capnography 2

Normal waveform of one respiratory cycle Height shows amount of CO2

Length equals time of exhalation

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Phase I: Respiratory Baseline Phase II: Expiratory Upstroke   Phase III: Expiratory Plateau ETCO2: Peak EtCO2 level Phase IV: Inspiratory Downstroke

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Normal range is 35-45mm Hg

Normal WaveformNormal Waveform

45

0

Page 20: Capnography 2

45

0

HypoventilationHypoventilation

NormalNormal

45

0

45

0

BronchospasmBronchospasm

HyperventilationHyperventilation

45

0

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Decreased ETCO2 is pattern for hyperventillationAnxietyRespiratory Alkalosis

Increased ETCO2 is pattern for Hypoventillation(air trapping)COPDRespiratory Acidosis

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“Shark Fin” shape to waveform

45

0

45

0

Normal

Bronchospasm

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Oxygenation and ventilation Pulse oximetry

Measures O2 saturation in blood Slow to indicate change in ventilation

Capnography Measures CO2 in the the airway Provides a breath-to-breath

status of ventilation

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ETCO2 is measured through expired ventillation End-tidal CO2

Normal EtCO2 range is 35-45mmHg Several conditions can be immediately

detected with capnography

Page 25: Capnography 2