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Medical Training - Monitoring - For internal use only
2 Objective of Presentation This presentation on Monitoring gives the reader an overview of current systems which can be used to monitor mechanical ventilation. It covers medical fundamentals and recognition of life- threatening situations. The reader will also become acquainted with the different priorities of alarms on MEDUMAT Transport. © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
3 Contents Ventilation Monitoring Pressure/Volume Curve Capnometry /Capnography MEDUMAT Transport Alarms
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Ventilation Monitoring Every use of mechanical ventilation has to be monitored continuously as a check of its effectiveness and success. In addition to oxygen saturation -- the sign of success – other measures are required for the assessment and management of the ventilation process. The following parameters can be used in an evaluation: –Clinic –Capnometry –Expiration volumetry –Ventilation pressures –(Blood Gas Analysis)
5 Important Parameters For Assessing the Quality of Ventilation Measurements: –Tidal volume –Respiratory Minute Volume –Respiratory rate –Maximum pressure –PEEP level –etCO 2 Curves –Flow curve –Pressure curve –Capnography © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
6 Pressure Curve Composition of Pressure/Time Diagram
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Flow Curve Composition Flow/Time Diagram
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Capnometry /Capnography Non-invasive continuous monitoring of CO 2 portion of exhaled air –Check position of tube –Check ventilation –Check circulatory function Sensitive monitoring process Two different reporting means –capnometry (numeric value) –capnography (curve)
9 Structure of CO 2 Curve in Capnogram I.Inspiration II.CO 2 of upper airways (dead space) III.CO 2 of lower airways (alveoli) IV.Start of next inspiration © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
10 Functional Principle of etCO 2 Measurement Infrared spectroscopy with wave length of 426 nm Absorption of light proportional to number of available CO 2 gas molecules © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
11 Interpretation of CO2 Curves Exponential decrease in PCO 2 –Cardiac arrest –Pulmonary embolism –Sudden decrease in blood pressure Constant low etCO2 –Absolute hyperventilation –Low body temperature –Centralization of shock Constant high etCO2 –Hypoventilation Sudden decrease in etCO2 –Accidental extubation –Faulty esophageal intubation –Disconnection Slant in etCO2 plateau –Bronchospasms (e.g., asthma) © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008
12 Influences on etCO2 Level In patients depending on: –Circulatory function and CO 2 transport to lungs –Metabolism at cellular level –Ventilation for respiratory elimination of CO 2
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Normal Capnometry /Capnography –etCO 2 in patient with normoventilation 4-5 Vol% = mm Hg –Conversion: 1 Vol% = 7 mmHg 1 mmHg = 0.15 Vol%
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Alarms Distinction between physiological and system alarms in MEDUMAT Transport Graduated in three (3) alarm escalation levels Requires individual adjustment for each patient
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Alarm – High Priority Tidal volume high/low Respiratory Minute Volume high/low Apnea Leak on patient side of device Expiratory CO 2 high/low Inspiratory CO 2 high Airway pressure high/low Oxygen supply low
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Alarms – Medium Priority Respiratory rate high Oxygen concentration high CO 2 Occlusion
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Alarm – Low Priority CO 2 module defective
© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June Summary Every ventilation of a patient requires that thorough checks be made of the ventilation settings by measuring physiological parameters. Knowing the etCO2 numerical values and curves gives the user a greater degree of safety and certainty during ventilation of emergency patients. Device-specific alarms in three different priority levels indicate problems or danger.
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