ETCO2 Capnography

4

46Young

Level 25 EMS Wizard
Messages
3,063
Reaction score
90
Points
48
We've been using the nasal ETCO2 capnography/capnometry for a while now, in addition to the ET attatchment. I know the basics, how to read the waveform, how to use it to help gauge treatment with a COPD pt, the asthmatic, the APE pt. We also routinely use ETCO2 for undifferentiated shortness of breath. I'm still weak as to what the broader implications of this monitoring can show. In general, what other medical conditions can the capnography be used for in dx and management. Same question for the capnometry numbers. Please weigh in with what you know, so that we can all benefit. Thanks!

Edit: An older medic, one who is known to be one of the best in the county by popular opinion, asked me how the ETCO2 was going to change my pt care, and what else it could be used for. He doesn't feel it is of much value, except to confirm tube placement in cardiac arrests and such.
 
Last edited by a moderator:
Just wondering, how does the nasal ETCO2 detectors work? No where around here uses it due to cost. I wish they did, I want to use it more

I would think with it being mixed in with room air as well it could be off?
 
Last edited by a moderator:
Curare cleft to help identify muscle relaxant usage and when they're about to wear / are wearing off.

cap9.gif





Can be used from everything from respiratory effort, helping determine respiratory acidosis/alkalosis, helping to determine SIRS, PEs, rapidly rising body temp... it can be used for quite a lot. Not always things that WE can change, but can be helpful in passing on... though I doubt most nurses I pass it on to even think twice about the number. Some just get a blank look if it's for anyone but an asthmatic.




Hockey said:
Just wondering, how does the nasal ETCO2 detectors work? No where around here uses it due to cost. I wish they did, I want to use it more
Click to expand...


There's a small tube coming off the NC at the lips that collects the expired CO2 and measures the amount.
 
Last edited by a moderator:
Linuss said:
There's a small tube coming off the NC at the lips that collects the expired CO2 and measures the amount.
Click to expand...


Does it ever get affected by other things such as room air though? Or not enough that it matters?
 
Not enough that it matters in my experience. Take one that you use on an ETT and just leave it in the open air--- it shouldn't read any ambient CO2. Same as the NC version.
 
I'm fond of this site for information on capno
http://emscapnography.blogspot.com/
Our LP12s have canpo capability and I tend to use it whenver I feel it might be useful and for every patient I tube.
 
PE - Usually low Spo2 and low Co2
Pneumothorax - Abnormal waveform (I don't have an example, sorry)
DKA - High CBG with low Co2

There are others but I haven't had enough caffeine to think of them.
 
Hockey said:
Does it ever get affected by other things such as room air though? Or not enough that it matters?
Click to expand...

They can get messed up when using them under CPAP or sometimes Nebs.
 
To be honest you just asked a question akin to "Guys what is an ECG good for other than telling heart rate?"

Capnography is an incredible tool which gives you information on everything from respiratory rate and volume to systemic metabolic activity and cardiac output.

In order to fully understand capnography you have to understand pH, and buffer systems and how they are effected by changes in metabolic, perfusion and respiratory states. What capnography shows you is entirely dependent upon what is going on with the patient, that's why it's such a valuable tool but also a difficult to understand one.

I can't type out all the information there is about capnography nor do I know all of it, but here are some resources to get you started.

http://www.capnography.com/
http://emscapnography.blogspot.com/
http://www.capnobase.org/
http://www.signavitae.com/attachments/049_SV 2008 3 Suppl 1 S 44 - 45.pdf

Once you have read up ask some specific questions.

For the record asking questions like "What is good about capnography?" on a forum is pretty poor form, there are a million resources on google if you just type in capnography, then if you have trouble understanding something or a specific question comes up you can come and post it here, but vague subject matter hopping for everything to be placed before you by other isn't a good way to learn.
 
Last edited by a moderator:
sdadam.....seriously.....you are advising him not to ask a question in a forum?

:rolleyes:

Why dont we just eliminate forums all together and we'll just google all our questions then ? Yes there are a million resources out there but he chose to come here for answers , possibly looking for some insight to the use of capnography in the pre-hospital environment since that is what this forum caters to .

Thanks for the links though......some good reads in there .
 
Last edited by a moderator:
Speedylifsavr said:
sdadam.....seriously.....you are advising him not to ask a question in a forum?

:rolleyes:

Why dont we just eliminate forums all together and we'll just google all our questions then ? Yes there are a million resources out there but he chose to come here for answers , possibly looking for some insight to the use of capnography in the pre-hospital environment since that is what this forum caters to .

Thanks for the links though......some good reads in there .
Click to expand...

Did you even read his post? He is spot on. Yes, don't ask general shotgun questions where the answer would fill an ocean sized container.
 
8jimi8 said:
Did you even read his post? He is spot on. Yes, don't ask general shotgun questions where the answer would fill an ocean sized container.
Click to expand...

Why not in this particular case? I haven't found any decent threads on this forum dedicated to ETCO2 monitoring in it's entirety, just an application here or there. Look, the thread produced a few good links, and some members weighed in with applications for ETCO2 beyond tube confirmation, air trapping with asthma/COPD, etc. I'm sure some prople picked up some useful information and links from this thread, so it wasn't a waste. It's not like I started a thread on stethoscopes, utility belts, EMT starting salary, why are there no EMT jobs, or what lights look the coolest on my POV.

Thanks, Speedy.
 
Please disregard my previous post. Let's keep this thread going I'm actually interested in it.
 
8jimi8 said:
Please disregard my previous post. Let's keep this thread going I'm actually interested in it.
Click to expand...

Good, glad to hear it. I hope we all get something out of it; that's why I started it in the first place.

Thanks for the contributions, everyone.
 
We currently only have in-line EtCO2 capability although I have suggested the cannula filter lines and we should be getting those soon. The ability to monitor EtCO2 is awesome! I love what all u can tell by CO2.

We all know its a priority and must for intubation. In an arrest, initial EtCO2 values have been shown to have a predictive value on ROSC. The EtCO2 level in low perfusion states is not reflective of ventilation but instead reflects circulation. Patients with EtCO2 below 15 have poor prognosis for ROSC.

It is a great tool to see in real-time response to treatment, use to differentiate between causes of resp distress, monitor OD patients or those being administered narcs and benzos.

Its also nice to see decompensation of pts in heart failure. As the CO drops and perfusion decreases a decreased EtCO2 will be noted.

This is a great thread. I have much more to learn on using Capnography and have observed there are still many who don't fully utilize this tool in their patient care.
 
You must log in or register to reply here.
Back
Top