the ultimate vital sign? importance of capnography in ems joshua erdman, bs, ccemt-p uw emergency...

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The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

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Page 1: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

The Ultimate Vital Sign?Importance of Capnography in EMS

Joshua Erdman, BS, CCEMT-PUW Emergency Education Center

Page 2: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

CO2 CO2

O2

CO2

O2 O2

The full cycleThe full cycle

Page 3: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

CO2 CO2

O2

CO2

O2 O2

The full cycle and The full cycle and our other vital signsour other vital signs

RRPulse

EKG

BP

Pulse ox

Capnography

Page 4: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

The full cycleThe full cycle

• Measuring CO2 allows us to look at:– Ventilation– Perfusion– Cellular metabolism

• And all instantly!

Page 5: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

CapnographyCapnography

• Technology uses the Infrared absorbing capability of CO2 to determine the amount in a sample of air

• Gives us a measurement in mmHg

• Can graph this amount over time

Page 6: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

TechnologyTechnology

• Two types– Mainstream

• Advantage: Fast

• Disadvantages: Bulky, usually only for intubated patients

– Sidestream• Advantages: Small samples, able to be used for spontaneous breathers

• Disadvantages: Slight time delay (<0.5 seconds)

Page 7: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Normal CapnogramNormal Capnogram

Page 8: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Capnogram Waveform

Phase Termed Variables Gas from

phase I A→B baseline A = completion of inspiration Large airwaysOropharynxnasopharynxB = beginning of expiration

phase II B→C expiratory upstroke

C = slowing of exhaled flow Intermediate airways mixes with phase I air

phase III C→D alveolar plateau D = end expiration = PETCO2 Mixed gas displaced by alveolar gas

phase IV D→E inspiratory downstroke

E= end inspiration Inspiratory gas has little CO2

Page 9: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Typical capnogramTypical capnogram

Page 10: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Capno vs. Pulse oxCapno vs. Pulse ox

Page 11: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

IntubationsIntubations

• The #1 reason most paramedics know to use capnography

• AHA now identifies as the BEST way to confirm your tube (2010 guidelines)

Page 12: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Sudden change while bagging…Sudden change while bagging…

Page 13: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Sudden decrease!Sudden decrease!

Page 14: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Ventilation ratesVentilation rates

• Normal value should be 35-45 mmHg

• When ventilating,– if too LOW, you need to SLOW

– if too HIGH, you need to FLY (go faster)

ETCO2 Vent. rate

Page 15: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

What the…?What the…?

Page 16: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

What’s going on here?What’s going on here?

Page 17: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Exponential decrease in CO2Exponential decrease in CO2

Page 18: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

CPR in progressCPR in progress

Page 19: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

CPR usesCPR uses

• Effective compressions

• ROSC

• Termination of CPR

• Should I even have started?

Page 20: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Spontaneous breathersSpontaneous breathers

• Asthma vs. hyperventilation

Page 21: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

HyperventilationHyperventilation

Page 22: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

BronchospasmBronchospasm

Page 23: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center
Page 24: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Spontaneous breathersSpontaneous breathers

• Overdose

• CHF

• Ketoacidosis

• Sepsis

• Hyperthermia

• MI, especially right-sided or inferior wall

Page 25: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Hmmm…Hmmm…

Page 26: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

In summary….In summary….

• Legal defense for intubations

• Immediate indication of changes in ventilation or perfusion

• Many clinical diagnosis possibilities when taken in consideration of other signs and symptoms

Page 27: The Ultimate Vital Sign? Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

Thanks!Thanks!

• Joshua Erdman

• UW Emergency Education Center

[email protected]