ETCO2 vs PaCO2

[zzyzx]

Here's an interesting lecture on whether or not you can use capnography to guide you in ventilating a patient:

http://www.emsonline.net/tuesday.asp?date=...0-08_Warner.flv

[FL_Medic]

Here's an interesting lecture on whether or not you can use capnography to guide you in ventilating a patient:

http://www.emsonline.net/tuesday.asp?date=...0-08_Warner.flv

Correction for ya, it is a lecture about ventilating TRAUMA patients. Excellent video, thanks for the link.

[Tom B.]

Was that "androgynous Pat" from SNL?

[FL_Medic]

Was that "androgynous Pat" from SNL?

haha, now that's funny.

[zzyzx]

Correction for ya, it is a lecture about ventilating TRAUMA patients. Excellent video, thanks for the link.

True, but he does also mention that the ETCO2 and PaCO2 won't match in drowning victims. He doesn't really go into other types of non-trauma cases.

Paging VentMedic....

[VentMedic]

Decent powerpoint with reasons for increased and decreased PetCO2 pr P(a - et)C02.

http://co-5.college-online.com/lisa_conry/...%20OXIMETRY.ppt

Free and easy registration.

http://elearning.respironics.com/index_f.asp

Under CEs, you should see these titles. You may have to register as "other" instead of EMT(P) to see all the courses.

Capnography: Principles and Clinical Application (very good)

Respiratory Monitoring: Principles and Clinical Application Of Volumetric Capnography

NPPV: Across the Continuum of Care

Clinical Application of Ventilator Waveforms and Trending

Appropriate Handling in the Neonatal Intensive Care Unit

Noninvasive Ventilation in the Home CEU

Under products:

BiPAP S/T® Training

BiPAP® AVAPS™ Training

BiPAP® Focus™ Training

BiPAP® Vision® Training

Cadence® Training

Esprit® Ventilator

French Esprit® Ventilator

NICO2® Respiratory Profile Monitor

Philips Respironics V60* Ventilator e-learning program

WhisperFlow®,

Criterion® 40 and 60 Monitors and

Criterion® OxyCheck™ Oxygen Analyzer Training

[zzyzx]

Thanks Vent!

[HERBIE1]

In my experience, the number of full arrest victims- where capnography is useless- far outweighs the patients intubated for only respiratory problems. Prehospital wise, capnography is most useful for extended transports which are not what most first response, urban areas see.

[VentMedic]

In my experience, the number of full arrest victims- where capnography is useless- far outweighs the patients intubated for only respiratory problems. Prehospital wise, capnography is most useful for extended transports which are not what most first response, urban areas see.

I disagree.

How do you now determine the effectiveness of CPR in the field moment to moment? Feel for pulses? Check pupils? The presence of femoral or carotid pulsations, pupillary signs, and arterial blood gas (ABG) results have not shown to correlate with successful CPR. In the hospital we may draw labs but even an ABG has its limitations and may be misleading with the gradient recognized by V/Q mismatching and venous paradox.

During cardiac arrest the partial pressure of end-tidal carbon dioxide (PetCO2) falls to very low levels, reflecting the very low cardiac output achieved with CPR. It has been shown that the PetCO2 achieved during advanced cardiac life support reliably predicts an outcome of cardiac arrest. Higher levels of the PetCO2 indicate better cardiac output, higher coronary perfusion pressure and a greater likelihood of successful resuscitation. After the onset of cardiac arrest caused by ventricular fibrillation, the PetCO2 abruptly decreases to nearly zero and then begins to increase after the onset of effective CPR. Further increase is detected upon return of spontaneous circulation (ROSC) to normal or above-normal levels.

For long transport the ETCO2 should not be the only observation relied on. In fact, we may not always use the ETCO2 monitor if the tube is secure and the ventilator settings are not being messed with. Our ventilators give us excellent wave forms and measured values. Correlated with other VS and a physical assessment, the pulmonary status can be well represented. Of course if it is an unstable CCT or HEMS, an ETCO2 monitor will be used. But even with that the PetCO2 number must be correlated with pt hx and assessment. The norm of "40" may not always be correct or appropriate for that patient. Experience may also need to be relied on that the ventilator settings are adequate for that patient and the number may be close to the PaCO2.

Now of course if all you have for a vent is an ATV you had been have some serious assessment skills. While it is designed to be "idiot proof", its simplicity has led to some very under educated providers using it.

Capnography should also be able on any truck that does RSI or other medication assisted intubation.

Edited July 11, 2009 by VentMedic