the ultimate vital sign? importance of capnography in ems
DESCRIPTION
The Ultimate Vital Sign? Importance of Capnography in EMS. Joshua Erdman, BS, CCEMT-P UW Emergency Education Center. CO2. CO2. CO2. O2. O2. O2. The full cycle. CO2. CO2. CO2. O2. O2. O2. The full cycle and our other vital signs. Capnography. EKG. RR. Pulse. BP. Pulse ox. - PowerPoint PPT PresentationTRANSCRIPT
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The Ultimate Vital Sign?Importance of Capnography in EMS
Joshua Erdman, BS, CCEMT-PUW Emergency Education Center
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CO2 CO2
O2
CO2
O2 O2
The full cycleThe full cycle
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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
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The full cycleThe full cycle
• Measuring CO2 allows us to look at:– Ventilation– Perfusion– Cellular metabolism
• And all instantly!
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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
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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)
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Normal CapnogramNormal Capnogram
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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
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Typical capnogramTypical capnogram
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Capno vs. Pulse oxCapno vs. Pulse ox
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IntubationsIntubations
• The #1 reason most paramedics know to use capnography
• AHA now identifies as the BEST way to confirm your tube (2010 guidelines)
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Sudden change while bagging…Sudden change while bagging…
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Sudden decrease!Sudden decrease!
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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
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What the…?What the…?
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What’s going on here?What’s going on here?
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Exponential decrease in CO2Exponential decrease in CO2
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CPR in progressCPR in progress
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CPR usesCPR uses
• Effective compressions
• ROSC
• Termination of CPR
• Should I even have started?
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Spontaneous breathersSpontaneous breathers
• Asthma vs. hyperventilation
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HyperventilationHyperventilation
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BronchospasmBronchospasm
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Spontaneous breathersSpontaneous breathers
• Overdose
• CHF
• Ketoacidosis
• Sepsis
• Hyperthermia
• MI, especially right-sided or inferior wall
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Hmmm…Hmmm…
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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