![]() The air leak resulting from the extrusion of the cannula under the mask is minimal and readily overcome by the high gas flows used. 2-4 The cannula type device should be placed prior to applying the NIV mask. To obtain accurate CO 2 measurements and waveforms while using NIV, sampling must be done using the nasal oral site with a cannula type device that incorporates an oral pillow (mentioned previously). Unlike BVM ventilation, the high gas flows generated during non-invasive ventilation (NIV) such as CPAP or BiPAP significantly washout CO 2. In BVM ventilation with a continuous mask seal maintained during exhalations, accurate CO 2 values and waveforms will be displayed when using an adapter connected between the bag and mask. For patients receiving positive pressure ventilation, CO 2 is measured using an adapter placed at the connection between the ventilation device or circuit and the advanced airway or mask being used on the patient. Capnography is available for both spontaneously breathing patients and patients who are receiving positive pressure ventilation.įor patients who are breathing spontaneously, exhaled CO 2 can be measured using a nasal cannula type device where one of the cannula prongs (and sometimes an additional collector positioned over the mouth, referred to as an “oral pillow,”) samples respiratory gases. In steady cardiac output and metabolic states, CO 2 production remains relatively constant, hence measuring exhaled CO 2 directly reflects ventilation. Capnography reflects ventilation, perfusion, and metabolism alternatively, pulse oximetry mirrors oxygenation status. During the 1980s, capnography became a standard for anesthesia care in the U.S., 1 virtually eliminating misplaced invasive and supraglottic airways. This column will explain how you can use end tidal CO 2 measurements to titrate and evaluate the effectiveness of CPAP.Ĭapnography is the non-invasive measurement of exhaled carbon dioxide (CO 2) displayed as a CO 2 waveform concentration over time. A very valuable, but often underused tool for evaluating the effectiveness of CPAP is capnography. In others (probably comprising the majority of BLS and ALS CPAP applications), it can be challenging to determine whether CPAP is helping, not making a difference or potentially harming your patient. In some situations, such as acute pulmonary edema, the beneficial effects of CPAP become apparent within seconds to minutes. There are very few reasons why any acutely dyspneic patient should not have at least a trial of CPAP. (Photo courtesy )ĬPAP (Continuous Positive Airway Pressure) is a valuable tool for a wide variety of patients with acute shortness of breath. A code summary should accompany all cardiac arrest reports.The image shows a significantly widened alpha angle, also referred to as “shark fin” capnography waves. Attach both strips to the completed run report.Upon arrival to the emergency department and after transferring the patient to the hospital’s bed/gurney obtain a second strip demonstrating a continued positive wave form.Document any airway or pharmacologic interventions based on capnography readings.Upon confirmation of successful endotracheal intubation or King Tube placement (positive wave form), print a strip and document the initial reading on the abbreviated report.Capnography device should remain in place for continuous monitoring, with frequent checks to ascertain that the tube does not migrate.Assure nasal cannula or sensor to E.T.Select EtCO2 setting on monitor if not set to default.Objective data to terminate resuscitation PROCEDURE: Hyperventilation: DKA, metabolic acidosis, Seizure, CHF, shock & circulatory compromiseĬPR: compression efficacy, early sign of ROSC, Verification of ETT or King Tube placementīronchospasm: asthma, COPD and anaphylaxisĮTT or King Tube surveillance during transport ![]() ![]() Procedure Guidelines 9.13 END TIDAL CO2 MONITORING CAPNOGRAPHY INDICATIONS: Intubated Applications (Mainstream) 1.1.4.6 BRONCHOSPASM: “Sharkfin” MANAGEMENT: Bronchodilators.1.1.4.5 HYPERVENTILATION: ↑RR, EtCO2 1.1.4.4 HYPOVENTILATION: ↓ RR, EtCO2 > 45 mm Hg MANAGEMENT: Assist ventilations/intubate.1.1.4.3 ESOPHAGEAL INTUBATION: Absence of waveform MANAGEMENT: Re-intubate.1.1.4.2 DISLODGED ETT: Loss of waveform, Loss of EtCO2 MANAGEMENT: Replace ETT.1.1.4.1 NORMAL – 35-45 mm Hg MANAGEMENT: Monitor.1.1 9.13 END TIDAL CO2 MONITORING CAPNOGRAPHY.
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