1. Capnography Taken from Zoll Medical Corp pamphlet on Capnography

2. Co2 Odorless, colorless gas Gives carbonated drinks their fizz Used to extinguish fires Created as a byproduct of cellular metabolism

3. Once Metabolized Produced in our tissues Diffuses into our venous blood Travels through the right side of the heart Eventually reaches the lungs where it is exchanged for oxygen

4. End Tidal Co2 Co2 levels peak at the end of exhalation This is when it is at maximum concentration Can be measured quickly and noninvasively with Capnography

5. How it works Capnography uses infrared technology to provide a continuous waveform called a capnogram It also provides a digital readout of Exhaled Co2

6. Why not just a pulse ox? Pulse Ox ◦Measures oxygen saturation levels ◦30-60 second delay in detecting deterioration ◦Can be affected by temperature and carbon monoxide Capnography ◦Reflects actual ventilations ◦Changes are seen rapidly and in as little as a half second *the 2 should always be used together

7. Not just for intubation Although Capnography is the gold standard for intubated patients, it is also good for: ◦Conscious sedations ◦Patients with acute respiratory events

8. What is normal? A reading between 35-45 mmHg is generally considered normal Levels greater than 45 indicate respiratory acidosis which may be due to inadequate ventilations or over sedation Levels less than 35 signal respiratory alkalosis typically caused by hyperventilation

9. The intubated patient Can verify placement of the ET tube Can provide feedback regarding ventilations Can indicate adequate or inadequate perfusion

10. The Non-Intubated Patient Can be an early indicator of bronchospasms in Asthma patients, COPD exacerbations or Anaphylaxis Can indicate hypoventilation from chronic heart failure, drug intoxication, respiratory failure or circulatory compromise

11. Reference 2011 Zoll Medical Corporation Capnography in Resuscitation: Peaks, Valleys, And Trends-Do They Signal the End? Mike Chumpner, BS MBA, CHF, NREMT-P