1. Capnography The EMS Version By: Ryan Felish

2. Why Capnography? Capnography – the measurement of carbon dioxide (CO2) in exhaled breath. Capnography provides an immediate picture of patient condition. Pulse oximetry is delayed. Hold your breath. Capnography will show immediate apnea, while pulse oximetry will show a high saturation for several minutes. In colorimetric capnography a filter attached to an ET tube changes color from purple to yellow when it detects carbon dioxide. This device has several drawbacks when compared to waveform capnography. It is not continuous, has no waveform, no number, no alarms, is easily contaminated, is hard to read in dark, and can give false readings.

3. Why Capnography While capnography is a direct measurement of ventilation in the lungs, it also indirectly measures metabolism and circulation. For example, an increased metabolism will increase the production of carbon dioxide increasing the ETCO2. A decrease in cardiac output will lower the delivery of carbon dioxide to the lungs decreasing the ETCO2.

4. Normal Values ETCO2 30-45 mm Hg is the normal value for capnography. The normal wave form appears as straight boxes on the monitor screen:

5. Waveform Explained A to B is post inspiration/dead space exhalation, B is the start of alveolar exhalation B-C is the exhalation upstroke where dead space gas mixes with lung gas C-D is the continuation of exhalation, or the plateau(all the gas is alveolar now, rich in C02) D is the end-tidal value – the peak concentration, D-E is the inspiration washout

6. Abnormal Values ETCO2 Less Than 35 mmHg = "Hyperventilation/Hypocapnia" Ph Increases (Alkalosis) ETC02 Greater Than 45 mmHg = “Hypoventilation/Hypercapnia" PH Decreases (Acidosis) Simply put, A number less than 35 means the patient is being ventilated too fast, and a number higher than 45 means the patient is ventilated too slow and is becoming acidotic.

7. Verifying Tube Placement Continuous end-tidal CO2 monitoring can confirm a tracheal intubation. A good wave form indicating the presence of CO2 ensures the ET tube is in the trachea. You're out (missed the chords). You have proper placement!

8. Extra Tips ETCO2 can be the first sign of return of spontaneous circulation (ROSC). During a cardiac arrest, if you see the CO2 number shoot up, stop CPR and check for pulses. End-tidal CO2 will often overshoot baseline values when circulation is restored due to carbon dioxide washout from the tissues. In a resuscitated patient, if you see the stabilized ETCO2 number significantly drop in a person with ROSC, immediately check pulses. You may have to restart CPR.

9. Function Of Our Units

10. Using The Printer Leave unit on after transfer, once the unit is shut off, you will not be able to print the records of the last patient. Turn printer on by pressing the mode button then face the Infrared ports at each other. On capnographer go to Menu, Printer. Be sure the values are set as: Format = Trend Tables (default value) Time Span = (set this to the max available setting) Interval = 90 seconds (other option is 15 seconds) Then press the start print button.

11. Notes On Our Units A patient who has a high amount of mucous or excretions may plug in inline filter and cause the unit to show incorrect readings, resort back to lung sounds and pulse ox. If you turn on the unit, but are unable to see anything, press the up arrow (contrast button) until the screen is clearly visible. Do the opposite if the screen is all black on start up. If you are still unable to view the screen, check your battery. To clean the unit, spray hero or other disinfectant onto a towel then wipe the unit and pulse ox cord. DO NOT SPRAY ANY LIQUID DIRECTLY AT UNIT OR CORD. Use of capnography is now required on all intubated patients when available. This is to replace the use of the EZ-Cap