The Ultimate Vital Sign? Importance of Capnography in EMS

1. The Ultimate Vital Sign?Importance of Capnography in EMS Joshua Erdman, BS, CCEMT-P UW Emergency Education Center

2. CO2 CO2 CO2 O2 O2 O2 The full cycle

3. CO2 CO2 CO2 O2 O2 O2 The full cycle and our other vital signs Capnography EKG RR Pulse BP Pulse ox

4. The full cycle • Measuring CO2 allows us to look at: • Ventilation • Perfusion • Cellular metabolism • And all instantly!

5. Capnography • Technology uses the Infrared absorbing capability of CO2 to determine the amount in a sample of air • Gives us a measurement in mmHg • Can graph this amount over time

6. Technology • Two types • Mainstream • Advantage: Fast • Disadvantages: Bulky, usually only for intubated patients • Sidestream • Advantages: Small samples, able to be used for spontaneous breathers • Disadvantages: Slight time delay (<0.5 seconds)

7. Normal Capnogram

9. Typical capnogram

10. Capno vs. Pulse ox

11. Intubations • The #1 reason most paramedics know to use capnography • AHA now identifies as the BEST way to confirm your tube (2010 guidelines)

12. Sudden change while bagging…

13. Sudden decrease!

14. Ventilation rates • Normal value should be 35-45 mmHg • When ventilating, • if too LOW, you need to SLOW • if too HIGH, you need to FLY (go faster) Vent. rate ETCO2

15. What the…?

16. What’s going on here?

17. Exponential decrease in CO2

18. CPR in progress

19. CPR uses • Effective compressions • ROSC • Termination of CPR • Should I even have started?

20. Spontaneous breathers • Asthma vs. hyperventilation

21. Hyperventilation

22. Bronchospasm

24. Spontaneous breathers • Overdose • CHF • Ketoacidosis • Sepsis • Hyperthermia • MI, especially right-sided or inferior wall

25. Hmmm…

26. In summary…. • Legal defense for intubations • Immediate indication of changes in ventilation or perfusion • Many clinical diagnosis possibilities when taken in consideration of other signs and symptoms

27. Thanks! • Joshua Erdman • UW Emergency Education Center • jerdman@uwhealth.org