1. The Standard of Care Capnography Created by Joshua English, EMT-P James Pointer, MD Mike Jacobs, EMT-P

8. Physiology oxygenation alveoli perfusion metabolism back to lungs capillary vein Ventilation Transport Cell Metabolism O2 + oxygen glucose energy CO2 The Standard of Care Capnography

10. Normal EtCO 2 Normal O2 CO2 The Standard of Care Capnography

11. Terminology Capnogram a real-time waveform record of the concentration of carbon dioxide in the respiratory gases Capnograph Capnogram waveform plus numerical value 38 mmHg CO2 The Standard of Care Capnography

12. Terminology EtCO 2 – End Tidal CO 2 The measurement of exhaled CO 2 in the breath Normal Range | 35-45 mmHg CO2 The Standard of Care Capnography

13. Normal Waveform A B C D E A TIME End of inspiration Beginning of exhalation End of exhalation Beginning of new breath Alveolar plateau 38 mmHg CO 2 The Standard of Care Capnography Clearing of anatomic dead space

14. Common Waveforms Normal mmHg RR 39 16 The Standard of Care Capnography

15. Common Waveforms Hyperventilation Hypoventilation mmHg RR mmHg RR 48 8 24 35 The Standard of Care Capnography

17. Terminology Sidestream An indirect method of measuring exhaled CO 2 in non-intubated patients Mainstream Direct method of measuring exhaled CO 2 with intubated patients The Standard of Care Capnography

18. Asthmatic Waveforms Shark Fin mmHg RR COPD patients have a difficult time exhaling gases This is represented on the capnogram by a shark fin appearance 45 18 The Standard of Care Capnography

19. EtCO 2 & Asthma Moderate Attack Mild Attack mmHg RR mmHg RR 28 38 36 20 The Standard of Care Capnography

20. EtCO 2 & Asthma Severe Attack mmHg RR Time To Get MOVING!!! The asthmatic who looks tired and has a shark fin appearance on the capnogram… IS HEADED FOR RESPIRATORY ARREST 49 9 The Standard of Care Capnography

21. The Head Injured Patient Carbon dioxide dilates the cerebral blood vessels, increasing the volume of blood in the intracranial vault and therefore increasing ICP Recognizing the head injured patient and titrating their CO 2 levels to the 30-35 mmHg range can help relieve the untoward effects of ICP The Standard of Care Capnography

22. The Head Injured Patient Titrate EtCO 2 mmHg RR Titration IS NOT hyperventilation. Intubating a head injured patient and using capnography gives a means to closely monitor CO 2 levels. 30 16 The Standard of Care Capnography Keep them between 30 and 35 mmHg

23. EtCO 2 and Cardiac Arrest The capnograph of an intubated cardiac arrest patient is a direct correlation to cardiac output Increase in CO 2 during CPR can be an early indicator of ROSC The Standard of Care Capnography

24. Termination of Resuscitation EtCO 2 measurements during a resuscitation give you an accurate indicator of survivability for patients under CPR Non-survivors < 10 mmHg Survivors > 30 mmHg ( to discharge) The Standard of Care Capnography

27. Troubleshooting Inadequate Seal mmHg RR As air escapes around the cuff during BVM respirations the waveform will distort, alerting you to a possibly deflated or damaged ET cuff 39 16 The Standard of Care Capnography

28. Troubleshooting Obstruction mmHg RR An obstructed ET tube may have an erratic EtCO 2 value with a very irregular waveform 39 16 The Standard of Care Capnography

29. Troubleshooting Rebreathing mmHg RR A capnogram that does not touch the baseline is indicative of a patient who is rebreathing CO 2 through insufficient inspiratory or expiratory flow 42 16 The Standard of Care Capnography

30. QUIZ The Standard of Care Capnography

31. Hypoventilation mmHg RR The Standard of Care Capnography 48 8

32. Rebreathing mmHg RR The Standard of Care Capnography 42 16

33. Esophageal Tube The Standard of Care Capnography

34. Asthma mmHg RR The Standard of Care Capnography 36 20

35. Normal mmHg RR The Standard of Care Capnography 39 16

36. Questions? The Standard of Care Capnography