capnometry and capnography in the emergency departmentezola.net/me/academic/petco2/petco2.pdf · 31...
TRANSCRIPT
![Page 1: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/1.jpg)
Capnometry and Capnographyin the Emergency Department
Reuben StrayerMcGill Emergency Medicine
1
![Page 2: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/2.jpg)
2
![Page 3: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/3.jpg)
3
MUHC Capabilities
![Page 4: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/4.jpg)
4Basic Physiology of CO2
.03%
Three forms
Classical use of [CO2]
Alveolus Continuum
Ward 1998
![Page 5: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/5.jpg)
5Measuring CO2
Capnometry & Capnography
![Page 6: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/6.jpg)
6Measuring CO2
Ward 1998
![Page 7: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/7.jpg)
7Measuring CO2
![Page 8: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/8.jpg)
8
PetCO2 vs. ScvO2
![Page 9: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/9.jpg)
9Measuring CO2
Infrared
.03%
Three forms
Classical use of [CO2]
Alveolus Continuum
![Page 10: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/10.jpg)
10Measuring CO2
Mainstream vs. Sidestream
Santos 1994
![Page 11: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/11.jpg)
11
Miller’s Anesthesia, 6th ed.
![Page 12: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/12.jpg)
12
Time lag
Sullivan 2005
![Page 13: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/13.jpg)
13Capnograph
Ward 1998
![Page 14: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/14.jpg)
14The PetCO2 Value
38
Sanders 1989
CO2 production Delivery of blood to lungs Alveolar ventilation
![Page 15: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/15.jpg)
15The PetCO2 Value
Increased PetCO2
Decreased central driveMuscle weakness
Diffusion problems
FeverBurns
HyperthyroidismSeizure
Bicarbonate RxROSC
Tourniquet
![Page 16: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/16.jpg)
16The PetCO2 Value
Decreased PetCO2
OverventilationHypothermia
SedationParalysis
Decreased CO
Ventilating nonperfused lung (dead space)
![Page 17: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/17.jpg)
17The PetCO2 Value
Ward 1998
Dead space ventilation
![Page 18: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/18.jpg)
18The PetCO2 Value
Shunt perfusion
Ward 1998 Santos 1994
![Page 19: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/19.jpg)
19a-ADCO2
3-5 mmHg
![Page 20: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/20.jpg)
20Interpretation of the capnogram
No CO2
Low PetCO2
Failure to ventilate
![Page 21: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/21.jpg)
21
Ward 1998
![Page 22: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/22.jpg)
22Interpretation of the capnogram
No CO2
Low PetCO2
Failure to ventilate Failure to circulate
![Page 23: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/23.jpg)
23Interpretation of the capnogram
Ward 1998
![Page 24: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/24.jpg)
24Interpretation of the capnogram
No CO2
Low PetCO2
Failure to ventilate Failure to circulate
Changes in the slope of phase II and III
![Page 25: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/25.jpg)
25
Kinked ETT
Interpretation of the capnogram
Ward 1998
![Page 26: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/26.jpg)
26
Obstructive lung disease
Interpretation of the capnogram
Ward 1998
![Page 27: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/27.jpg)
27
Curare cleft
Interpretation of the capnogram
Ward 1998
![Page 28: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/28.jpg)
28Interpretation of the capnogram
Cardiogenic oscillations
Cuff leak
Ward 1998
![Page 29: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/29.jpg)
29Use in the confirmation of tracheal intubation
Prehospital BVM
![Page 30: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/30.jpg)
30Use in the confirmation of tracheal intubation
Leong 2005
![Page 31: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/31.jpg)
31
Supraglottic ETT
Use in the confirmation of tracheal intubation
Cardiac arrest
Do not rely on capnometry exclusively
auscultation of breath soundsabsence of gastric sounds
observation of chest motionappropriate compliance of the bag-valve assembly
tube condensationabsence of gastric contents in the tube
palpation of the tube cuff in the suprasternal notchuse of a lighted stylet
use of an esophageal detector devicechest radiography
bronchoscopypulse oximetry
Li 2000 Montauk 1996 Li 2006
6 breaths
![Page 32: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/32.jpg)
32Use in displaying the respiratory rate
![Page 33: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/33.jpg)
33Use in displaying the respiratory rate
![Page 34: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/34.jpg)
34Use in displaying the respiratory rate
![Page 35: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/35.jpg)
35Use in displaying the respiratory rate
![Page 36: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/36.jpg)
36Use in displaying the respiratory rate
![Page 37: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/37.jpg)
37Use in displaying the respiratory rate
In search of a reliable RR Transthoracic impedance
![Page 38: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/38.jpg)
38Use in displaying the respiratory rate
![Page 39: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/39.jpg)
39Use in displaying the respiratory rate
Biro 1994 Greenberg 2006
![Page 40: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/40.jpg)
40Use in displaying the respiratory rate
tcPCO2
![Page 41: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/41.jpg)
41Use in CPR
CO2 production, alveolar ventilation, and pulmonary perfusion
![Page 42: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/42.jpg)
42Use in CPR
![Page 43: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/43.jpg)
43Use in CPR
Santos 1994
![Page 44: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/44.jpg)
44Use in CPR
CO2 production, alveolar ventilation, and pulmonary perfusion
PetCO2 reflects the adequacy of CPR
Long downtimes
Obstructive causes of cardiac arrest
![Page 45: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/45.jpg)
45Use in CPR
Rosen’s Emergency Medicine, 4th ed.
![Page 46: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/46.jpg)
46Use in CPR
Rosen’s Emergency Medicine, 4th ed.
Pseudo-PEA
![Page 47: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/47.jpg)
47Use in CPR
CO2 production, alveolar ventilation, and pulmonary perfusion
PetCO2 reflects the adequacy of CPR
Long downtimes
Obstructive causes of cardiac arrest
Bicarb & epi
![Page 48: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/48.jpg)
48Use in CPR
Rosen’s Emergency Medicine, 4th ed.
![Page 49: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/49.jpg)
49Use in CPR
CO2 production, alveolar ventilation, and pulmonary perfusion
PetCO2 reflects the adequacy of CPR
Long downtimes
Obstructive causes of cardiac arrest
Bicarb & epi
Guiding the termination of resuscitative efforts
![Page 50: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/50.jpg)
50Use in CPR
Koetter 1999
![Page 51: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/51.jpg)
51Use in CPR
![Page 52: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/52.jpg)
52Use in CPR
CO2 production, alveolar ventilation, and pulmonary perfusion
PetCO2 reflects the adequacy of CPR
Long downtimes
Obstructive causes of cardiac arrest
Bicarb & epi
Guiding the termination of resuscitative efforts
Summary
![Page 53: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/53.jpg)
53Use as a PaCO2 surrogate
![Page 54: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/54.jpg)
54Use as a PaCO2 surrogate
![Page 55: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/55.jpg)
55Use as a PaCO2 surrogate
![Page 56: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/56.jpg)
56Use in procedural sedation
Chest rise
Hasel 2003 Cote 1991
![Page 57: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/57.jpg)
57Use in procedural sedation
Stemp 2005 Walker 2004
![Page 58: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/58.jpg)
58Use in procedural sedation
McQuillen 2000 McNulty 1990
![Page 59: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/59.jpg)
59Use in procedural sedation
Chest rise
Not good enough
![Page 60: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/60.jpg)
60Use in the management of asthma
Yaron 1996
![Page 61: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/61.jpg)
61Use in the diagnosis of pulmonary embolism
PE makes dead space
vs. the A-a gradient
![Page 62: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/62.jpg)
62Use in the diagnosis of pulmonary embolism
Ward 1998
![Page 63: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/63.jpg)
63Use in the diagnosis of pulmonary embolism
Kline 1998
![Page 64: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/64.jpg)
64Use in the diagnosis of pulmonary embolism
![Page 65: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/65.jpg)
65Use in the measurement of cardiac output
VO2 = (CO x CA) - (CO x CV)
CO = VO2 / (CA - CV)
Cardiac Output = Oxygen Consumption / Arteriovenous Oxygen Difference
![Page 66: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/66.jpg)
66Conclusion
CO Physiology
The Capnograph
Confirming ETT placementDisplaying respiratory rate
Guiding CPRPaCO2 surrogate
Procedural sedationAsthma
PECardiac output
![Page 67: Capnometry and Capnography in the Emergency Departmentezola.net/me/academic/PetCO2/PetCO2.pdf · 31 Corbo, J. Concordance between capnography and arterial blood gas measurments of](https://reader035.vdocument.in/reader035/viewer/2022071006/5fc328096ff0c904292c4a1f/html5/thumbnails/67.jpg)
67
1 ACEP Policy Statements, in Ann Emerg Med 1995 25(3): 441.2 Waeckerle, JF. End-tidal CO2 detecters stir controversy. Ann Emerg Med 1994: 24(2) 320.3 Ward, KR and Yearly, DM. End-tidal carbon dioxide monitoring in emergency medicine, part 1: Basic principles. Academic Emergency Medicine 1998; 5(6):628.4 Sullivan, KJ. End-tidal Carbon Dioxide Monitoring in Pediatric Emergencies. Ped Emerg Care 2005; 21(5): 327.5 Ward, KR and Yearly, DM. End-tidal carbon dioxide monitoring in emergency medicine, part 2: Clinical applications. Academic Emergency Medicine 1998; 5(6):637.6 Santos, LJ. Practical uses of end-tidal carbon dioxide monitoring in the emergency department. JEM 1994; 12(5): 633.7 Miller's Anesthesia, 6th ed. p1456.8 Sanders, AB. Capnometry in Emergency Medicine. Annals of Emergency Medicine 1989; 18(12): 1287.9 Leong, MT. The effect of vinegar on colorimetric end-tidal carbon dioxide determination after esophageal intubation. JEM 2005; 28(1) 5.10 Li, J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. JEM 2001: 20(3) 223.11 Montauk, L. False-positive end-tidal CO2. Ann Emerg Med 1996; 28(4): 458.12 Li, James. Personal communication, 2006.13 Kory, RC. Routine measurment of the respiratory rate: an expensive tribute to tradition. JAMA 1957; 165(5): 449.14 Gravelyn, TR. Respiratory rate as an indicator of acute respiratory dysfunction. JAMA 1980; 244(10): 1123.15 Edmonds, ZV. The reliability of vital sign measurements. Ann Emerg Med 2002; 39(3): 233.16 Lovett, PB. The vexatious vital: Neither clinical measurements by nurses nor an electronic monitor provides accurate measurements of respiratory rate in triage. Ann Emerg Med 2005; 45(1): 68.17 Goyal, M. Images in Emergency Medicine. Ann Emerg Med 2005; 46(5): 469.18 Brookes, CN. The PEP respiratory monitor: a validation study. EMJ 2003; 20: 326.19 Biro, Electrically amplified precordial stethoscope. J Clin Monit 1994; 10: 410.20 Greenberg, M. Makeshift use of a syringe, scalpel blade, and a stopcock to create a precordial stethoscope bell. J Clin Anest 2006; 18: 79. 21 Parker, SM. Evaluation of a transcutaneous carbon dioxide monitor (TOSCA) in adult patients in routine respiratory practice. Resp Med: June 28, 2006 (epub). 22 Ornato, JP. Relationship between cardiac output and the end-tidal carbon dioxide tension. Ann Emerg Med 1990; 19(10) 1103.23 Idris, AH. End-tidal carbon dioxide during extremely low cardiac output. Ann Emerg Med 1994; 23(3): 568.24 Morrison, LJ. Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. NEJM 2006; 355(5): 478.25 Rosen's Emergency Medicine, 4th Ed.26 Koetter, KP. Effectiveness of mechanical versus manual chest compressions in out-of-hospital cardiac resuscitation (letter). Am J Emerg Med 1999; 17(2): 210. 27 Wayne, MA. Use of End-tidal carbon dioxide to predict outcome in prehospital cardiac arrest. Ann Emerg Med 1995; 25(6) 762.28 Levine. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. NEJM 1997; 337(5): 301. 29 Barton, CW. Correlation of end-tidal CO2 measurements to arterial PaCO2 in nonintubated patients. Ann Emerg Med 1994; 23(3):560.30 Yosefy, C. End tidal carbon dioxide as a predictor of the arterial PCO2 in the emergency department setting. EMJ 2004; 21: 557.31 Corbo, J. Concordance between capnography and arterial blood gas measurments of carbon dioxide in acute asthma. Ann Emerg Med 2004; 46(4):323.32 Hasel, Ray. Personal communication, 2003.33 Cote CJ. A single blind study of combined pulse oximetry and capnography of children. Anesthesiology 1991; 74:980.34 Witting, MD. The sensitivity of room-air pulse oximetry in the detection of hypercapnia. Am J Emerg Med 2005; 23: 497.35 Stemp, LI. Pulse oximetry in the detection of hypercapnia (letter). Am J Emerg Med; 2006 24(1): 136.36 Walker, BH. Is capnography necessary for propofol sedation? (letter) Ann Emerg Med 2004; 44(5): 549.37 Wright, SW. Conscious sedation in the emergency department: The value of capnography and pulse oximetry. Ann Emerg Med 1992; 21(5): 551.38 McQuillen, KK. Capnography during sedation/analgesia in the pediatric emergency department. Ped Em Care 2000; 16(6): 401.39 McNulty SE. Relationship between arterial carbon dioxide and end-tidal carbon dioxide when a nasal sampling port is used. J Clin Monit 1990 Apr; 6(2): 93.40 Yaron M. Utility of the expiratory capnogram in the assessment of bronchospasm. Ann Emerg Med 1996. 28: 403.41 Kline, JA. Preliminary study of the capnogram waveform area to screen for pulmonary embolism. Ann Emerg Med 1998; 32(3): 289.42 Kline, JA. Measurement of expired carbon dioxide, oxygen and volume in conjunction with pretest probability estimation as a method to diagnose and exclude pulmonary venous thromboembolism. Clin Physiol Funct Imaging 2006; 26: 212.
References