03 capnography

Click here to load reader

download 03 capnography

of 101

  • date post

    07-May-2015
  • Category

    Documents

  • view

    5.374
  • download

    4

Embed Size (px)

Transcript of 03 capnography

  • 1.NON-INVASIVE C A PNOGRAPHY ALS Blue In-Service Part III

2. Oxygenation and Ventilation

  • What is the difference?

3. Oxygenation and Ventilation Oxygenation (oximetry ) Cellular Metabolism Ventilation (capnography) CO 2 O 2 4. Oximetry and Capnography

  • Pulse oximetry measures oxygenation
  • Capnography measures ventilation and provides a graphical waveform available for interpretation

5. Oxygenation

  • Measured by pulse oximetry (SpO 2 )
    • Noninvasive measurement
    • Percentage of oxygen in red blood cells
    • Changes in ventilation take minutesto be detected
    • Affected by motion artifact, poor perfusionand some dysrhythmias

6. Oxygenation Pulse Oximetry Sensors Pulse Oximetry Waveform 7. Ventilation

  • Measured by the end-tidal CO 2
    • Partial pressure (mmHg) or volume (% vol) ofCO 2in the airway at the end of exhalation
    • Breath-to-breath measurement providesinformation within seconds
    • Not affected by motion artifact, poor perfusion or dysrhythmias

8. Ventilation Capnography waveform CapnographyLines 9. Oxygenation and Ventilation

  • Oxygenation
    • Oxygen for metabolism
    • SpO 2measures% of O 2in RBC
    • Reflects change in oxygenation within5 minutes
  • Ventilation
    • Carbon dioxidefrom metabolism
    • EtCO 2measures exhaled CO 2atpoint of exit
    • Reflects change in ventilation within10 seconds

10. Oxygenation versus Ventilation

  • Monitor your ownSpO 2and EtCO 2
  • SpO 2waveform is in the second channel
  • EtCO 2waveform is in the third channel

11. Oxygenation versus Ventilation

  • Now hold your breath
  • Note what happens tothe two waveforms

How long did it take theEtCO 2waveform to go flat line? How long did it take theSpO 2to drop below 90%? SpO 2 EtCO 2 12.

  • Numeric reading: HR 100
  • Waveform:

13.

  • Numeric reading: HR 100
  • Waveform:

14. Capnography in EMS 15. Capnography in EMS

  • Low-flow sidestream technology

16. Using Capnography

  • Immediate information viabreath-to-breath monitoring
  • Information on the ABCs
    • Airway
    • Breathing
    • Circulation
  • Documentation

17. Using Capnography

  • Airway
    • Verification of ET tube placement
    • Continuous monitoring ofET tube position
  • Circulation
    • Check effectiveness of cardiac compressions
    • First indicator of ROSC
    • Monitor low perfusion states

Airway

    • Circulation

18. Using Capnography

  • Breathing
    • Hyperventilation
    • Hypoventilation
    • Asthma
    • COPD

19. Using Capnography

  • Documentation
    • Waveforms
      • Initial assessment
      • Changes with treatment
    • EtCO 2values
      • Trends over time
    • Waveforms

Trends 20. Why Measure Ventilation Intubated Patients

  • Verify and document ET tube placement
  • Immediately detect changes in ET tube position
  • Assess effectiveness of chest compressions
  • Earliest indication of ROSC
  • Indicator of probability of successful resuscitation
  • Optimally adjust manual ventilations in patients sensitive to changes in CO 2

21.

  • A 2005 study comparing field intubations that used capnography to confirm ETT placement vs. non-capnography use showed a 0% unrecognized misplaced ETT and 23% in the non-EtCO2 monitored group
  • Confirm ETI with waveform capnography!!

22. Why Measure Ventilation Non-Intubated Patients

  • Objectively assess acuterespiratory disorders
    • Asthma
    • COPD
  • Possibly gauge response to treatment

23. Why Measure Ventilation Non-intubated Patients

  • Gauge severity of hypoventilation states
    • Drug and ETOH intoxication
    • Congestive heart failure
    • Sedation and analgesia
    • Stroke
    • Head injury
  • Assess perfusion status
  • Noninvasive monitoring of patients in DKA

24. End-tidal CO 2(EtCO 2 ) Ventilation Perfusion Pulmonary Blood Flow RightVentricle Left Atrium r r O x y g e n O 2 C O 2 O 2 V e i n A t e y 25. a-A Gradient r r Alveolus PaCO 2 V e i n A t e y Ventilation Perfusion a rterial toA lveolar Difference for CO 2 RightVentricle Left Atrium EtCO 2 26. End-tidal CO 2(EtCO 2 )

  • Normal a-A gradient
    • 2-5mmHg difference between the EtCO 2 and PaCO 2in a patient with healthy lungs
    • Wider differences found
      • In abnormal perfusion and ventilation
      • Incomplete alveolar emptying
      • Poor sampling

27. End-tidal CO 2(EtCO 2 )

  • Reflects changes in
    • Ventilation - movement of air in andout of the lungs
    • Diffusion - exchange of gases between the air-filled alveoli and the pulmonary circulation
    • Perfusion- circulation of blood

28. End-tidal CO 2(EtCO 2 )

  • Monitors changes in
    • Ventilation - asthma, COPD, airway edema, foreign body, stroke
    • Diffusion- pulmonary edema,alveolar damage, CO poisoning, smoke inhalation
    • Perfusion - shock, pulmonary embolus, cardiac arrest,severe dysrhythmias

29. Physiological Factors Affecting ETCO 2Levels 30. Interpreting EtCO 2and the Capnography Waveform

  • Interpreting EtCO 2
    • Measuring
    • Physiology
  • Capnography waveform

31. Capnographic Waveform

  • Normal waveform of one respiratory cycle
  • Similar to ECG
    • Height shows amount of CO 2
    • Length depicts time

32. Phase 1

  • First Upstroke of the capnogram waveform
  • Represents of gas exhaled from upper airways (I.e. anatomical dead space)

33. Phase 2

  • Transitional Phase from upper to lower airway ventilation, and tends to depict changes in perfusion

34. Phase 3

  • Represents alveolar gas exchange, which indicates changes in gas distribution
  • All increases of the slope of Phase 3 indicates increased maldistribution of gas delivery

35. Capnographic Waveform

  • Waveforms on screen and printoutmay differ in duration
    • On-screen capnography waveform is condensed to provide adequate information the in 4-second view
    • Printouts are in real-time
    • Observe RR on device

36. Capnographic Waveform

  • Capnograph detects only CO 2 from ventilation
  • No CO 2present during inspiration
    • Baseline is normally zero

Baseline 37. Capnogram Phase I Dead Space Ventilation

  • Beginning of exhalation
  • No CO 2present
  • Air from trachea,posterior pharynx,mouth and nose
    • No gas exchangeoccurs there
    • Called dead space

38. Deadspace 39. Capnogram Phase IBaseline Beginning of exhalation A B I Baseline 40. Capnogram Phase II Ascending Phase

  • CO 2 from the alveoli begins to reach the upper airway and mix with the dead space air
    • Causes a rapid rise in the amount of CO 2
  • CO 2 now present and detected in exhaled air

41. Capnogram Phase II Ascending Phase CO 2present and increasing in exhaled air II A B C Ascending Phase Early Exhalation 42. Capnogram Phase III Alveolar Plateau

  • CO 2rich alveolar gas now constitutes the majority of theexhaled air