Medical Training - Monitoring - For internal use only

Objective of Presentation © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 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.

Contents Ventilation Monitoring Pressure/Volume Curve © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Contents Ventilation Monitoring Pressure/Volume Curve Capnometry /Capnography MEDUMAT Transport Alarms

Ventilation Monitoring © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 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)

Important Parameters For Assessing the Quality of Ventilation © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Important Parameters For Assessing the Quality of Ventilation Measurements: Tidal volume Respiratory Minute Volume Respiratory rate Maximum pressure PEEP level etCO2 Curves Flow curve Pressure curve Capnography

Pressure Curve Composition of Pressure/Time Diagram © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Pressure Curve Composition of Pressure/Time Diagram

Flow Curve Composition Flow/Time Diagram © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Flow Curve Composition Flow/Time Diagram

Capnometry /Capnography © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Capnometry /Capnography Non-invasive continuous monitoring of CO2 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)

Structure of CO2 Curve in Capnogram © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Structure of CO2 Curve in Capnogram Inspiration CO2 of upper airways (dead space) CO2 of lower airways (alveoli) Start of next inspiration

Functional Principle of etCO2 Measurement © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Functional Principle of etCO2 Measurement Infrared spectroscopy with wave length of 426 nm Absorption of light proportional to number of available CO2 gas molecules

Interpretation of CO2 Curves © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Interpretation of CO2 Curves Exponential decrease in PCO2 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)

Influences on etCO2 Level © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Influences on etCO2 Level In patients depending on: Circulatory function and CO2 transport to lungs Metabolism at cellular level Ventilation for respiratory elimination of CO2

Normal Capnometry /Capnography © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Normal Capnometry /Capnography etCO2 in patient with normoventilation 4-5 Vol% = 30-35 mm Hg Conversion: 1 Vol% = 7 mmHg 1 mmHg = 0.15 Vol%

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Alarms Distinction between physiological and system alarms in MEDUMAT Transport Graduated in three (3) alarm escalation levels Requires individual adjustment for each patient

Alarm – High Priority Tidal volume high/low © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Alarm – High Priority Tidal volume high/low Respiratory Minute Volume high/low Apnea Leak on patient side of device Expiratory CO2 high/low Inspiratory CO2 high Airway pressure high/low Oxygen supply low

Alarms – Medium Priority © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Alarms – Medium Priority Respiratory rate high Oxygen concentration high CO2 Occlusion

Alarm – Low Priority CO2 module defective © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 Alarm – Low Priority CO2 module defective

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO © WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 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.