capnography

[paraloco]

Do any of you use capnography frequently? Do you alter you treatment based on findings from it?

[bbbrammer]

We have capnography, and I almost never remember to use it. However when I do use it I don't change my treatment approach because most of the time capnography gives you a better idea of what is going on with the pt., but it usually isn't anything that is directly treated on the truck. For example, if you think your pt. is having an asthma attack, and the capnography confirms it, you will still be treating them with oxygen and nebulizer medications, even if the capnography didn't confirm it. The treatment doesn't really differ, just the understanding that you have aquiered one more piece to the puzzle.

[AZCEP]

We have it, and yes it can change the treatment that is provided.

Intubated cardiac arrest, for example. If the patient has minimal CO2 detected following 2 minutes of compressions, there is less likelihood that they will be resuscitated. Consideration to terminate can be made much earlier, regardless of the rhythm that is found.

Reactive airway disorders: you can gauge the effectiveness of the treatment you are providing based on the waveform. If the patient is unable to adequately ventilate the distal airways, you will see a change in the waveform and the numerical value when the treatment you are using starts to work.

COPD: Because of the pathophysiology of the disease, the waveform is different from normal to start. When treatment is effective the wave will "normalize".

In any of these situations, you will alter your treatment plan based on the information that you receive. Your assessment and the information from the capnography should work together to tell you how effective you are treating the patient. Capnography alone can't tell you, and neither can a good assessment.

[medic001918]

We do use capnography. It's requried for every intubated patient. But we also have nasal end tidal monitoring. This is valuable when you look at different wave forms to help realize the underlying pathophysiology of your patients condition, but more importantly to gauge how effective (or ineffective) your intervention is. There is a great deal to be learned from capnography and in all reality is a better indication of a patients respiratory status than pulse oximetry.

Some recommended reading:

http://emscapnography.blogspot.com/ written by a paramedic that works for the same service that I do.

Shane

NREMT-P

[Ridryder 911]

I agree, if used properly and having a true understanding of the use and application of capnography, one can utilize this tool much more. It has been described as ..."just as the ECG is important for hearts, the capnography is for respiratory systems"...

Actually, I believe capnography is more important tool over the pulse oximetry. Since this measures the respiratory system, where as the oximetry measures the absorption of oxygen which can take up to for 4-6 minutes to change.

Presentations of CHF versus Obstructive or mixture can be determined, since respiratory med's can actually cause harm or damage if not needed. (Yes, it is not wise to give nebulizers to CHF).. as well help aid in the diagnosis of DKA.

The neat thing as well it can be used from neonate to geriatric age, it is not affected by movement (such as seizures) and produces no artifact. This tool as well can be used in exposure to toxic agents (such as nerve gases, etc).

Unfortunately, most EMS personal do not use this tool often enough because the lack of understanding and education in capnography.

R/r 911

[tniuqs]

We have it, and yes it can change the treatment that is provided.

Intubated cardiac arrest, for example. If the patient has minimal CO2 detected following 2 minutes of compressions, there is less likelihood that they will be resuscitated. Consideration to terminate can be made much earlier, regardless of the rhythm that is found.

Agreed:

In addition on a ventilated patient with an acceptable blood pressure and dependant on Patho one "can" make changes to numerous ventilator settings and improve ventilation and oxygenation.

Reactive airway disorders: you can gauge the effectiveness of the treatment you are providing based on the waveform. If the patient is unable to adequately ventilate the distal airways, you will see a change in the waveform and the numerical value when the treatment you are using starts to work.

COPD: Because of the pathophysiology of the disease, the waveform is different from normal to start. When treatment is effective the wave will "normalize".

Got any studies there would love to see any "sharks fin" research.

So just what is "Normal" for a "COPDer" an Asthmatic or a healthy patient?

In any of these situations, you will alter your treatment plan based on the information that you receive.

Can you explain how and why this may alter treatment, specfically what treatment, If you would be so kind.

Your assessment and the information from the capnography should work together to tell you how effective you are treating the patient. Capnography alone can't tell you, and neither can a good assessment.

Bit confused here, are you saying a good assessment is not possible without ETCO2, I don't think that is what your implying but please correct me (not trying to put words in your mouth)

Has anyone heard or read of" Volumetric ETC02 monitoring" in present applications for EMS, it maybe the future of ETCO2 ?

This tread could turn ito a great teaching post if given half chance.

cheers

[tniuqs]

I agree' date=' if used properly and having a true understanding of the use and application of capnography, one can utilize this tool much more. It has been described as ..."just as the ECG is important for hearts, the capnography is for respiratory systems"... [/quote']

Yes understanding this device could lead to improved care.

An interesting comment, I have seen delayed response to the floors COPDer, but in most cases almost an immediate result in observed with Pulse Oximetry (with appropriate perfusion) Try this: place it on your finger, take a deep breath then push or vaso vagal yourself. One should see an almost immediate drop in heart rate... a very rapid resonse, then when everything reach's equelibrium take some really big breaths, Hypeventilate (so to speak) you should observe a drop in sats initally and then a delayed improvement in sat numbers, an interesting observation I have always wondered why?

Generally speaking Respiratory failure kills far faster than Ventilatory failure, not trying to be being picky here but there is a clear definition of both.

Please explain why bronchodilation or "not wise to give nebulizers to CHF" if this is a goal for improved oxygenation in a CHF patient an "adverse effect" ? I have never heard of this, please enlighten us, thanks.

btw Let us not got get into recient a therom that Oxygen is detrimental to the CHF patient, as that study only had only 24 patient's in that study group, and was very shody study to begin with.

Agreed: But during Grand Mal siezures the muscles can be "ineffective" so how does this assist in treatment other than the fact that they are not exchanging air?

The window in mainstream evaluation can becomed "fogged" or affected by secretions and some have delay to heat the window up as well, there are some artifacts that can be resolved easily, agreed, throw in a humidvent/Dar/ whatever you call em down there in line.

Generally speaking if one has a consistant reading its fairly reasonable to say it is giving you an accurate reading.

ETCO2 is not effected as P.O. with ambiant sunlight, not affected by wierd and wonderful heamotologic (is that a word?) stuff.

With some sidestream type ETCO2 the mls per minute should be adjusted, for the intubated or pediatric patient this giving more accurate readings ie from 90 mls per minute to 150 mls per minute (dependant on) Propac or LP 12.

Maybe that can change, I hope so.

R/r 911

[AZCEP]

Reactive airway disorders: you can gauge the effectiveness of the treatment you are providing based on the waveform. If the patient is unable to adequately ventilate the distal airways, you will see a change in the waveform and the numerical value when the treatment you are using starts to work.

COPD: Because of the pathophysiology of the disease, the waveform is different from normal to start. When treatment is effective the wave will "normalize".

]Got any studies there would love to see any "sharks fin" research.

So just what is "Normal" for a "COPDer" an Asthmatic or a healthy patient?

I would recommend looking at www.capnography.com for the expected waveforms

In any of these situations, you will alter your treatment plan based on the information that you receive.

Can you explain how and why this may alter treatment, specfically what treatment, If you would be so kind.

You will be able to make a real-time determination on the ventilatory status of the patient. You will also be able to determine if the specific treatment you are using is making a difference, or the patient is not responding to it.

Your assessment and the information from the capnography should work together to tell you how effective you are treating the patient. Capnography alone can't tell you, and neither can a good assessment.

Bit confused here, are you saying a good assessment is not possible without ETCO2, I don't think that is what your implying but please correct me (not trying to put words in your mouth)

Good point. I didn't write that comment too clearly, now did I? :roll: A good assessment is possible without it, but to determine how effective treatment is a continuous trend of ventilations is very useful. Many times it is very difficult to elicit audible breath sounds, and capnography adds to the ability to make good clinical decisions. We should all be able to base initial treatment on the patient presentation, but more information is useful for the decision making process.

[tniuqs]

"AZCEP"

I would recommend looking at www.capnography.com for the expected waveforms

Hey great site.

Thanks for the link!