View source for End Tidal CO2 Monitoring and Capnography

==Procedure Guidelines==
===9.13 END TIDAL CO2 MONITORING CAPNOGRAPHY===


====INDICATIONS:====
{| class="wikitable"
|-
! Intubated Applications (Mainstream) !! Non-Intubated Applications (Sidestream)
|-
| Verification of ETT or King Tube placement|| Bronchospasm: asthma, COPD and anaphylaxis
|-
| ETT or King Tube surveillance during transport|| 
Hypoventilation: drug overdose, stroke, <br /> seizure, CHF, shock & circulatory compromise
|-
| CPR: compression efficacy, early sign of ROSC,<br /> survival predictor*|| Hyperventilation: DKA, metabolic acidosis, <br /> sepsis, CNS Hyperventilation
|-
| Optimize ventilation of patients|| 
|}

'''''Objective data to terminate resuscitation'''''

====PROCEDURE:====
* Select EtCO2 setting on monitor if not set to default
* Assure nasal cannula or sensor to E.T. tube or King Tube is correctly placed
* Check for wave forms
* Record wave form
* Capnography device should remain in place for continuous monitoring, with frequent checks to ascertain that the tube does not migrate.
* At hospital, record waveform again


====DOCUMENTATION:====
* Upon confirmation of successful endotracheal intubation or King Tube placement (positive wave form), print a strip and document the initial reading on the abbreviated report.
* Document any airway or pharmacologic interventions based on capnography readings.
* Upon arrival to the emergency department and after transferring the patient to the hospital’s bed/gurney; obtain a second strip demonstrating a continued positive wave form.
* Attach both strips to the completed run report. A code summary should accompany all cardiac arrest reports.


====CAPNOGRAPHY WAVEFORM ANALYSIS:====

=====NORMAL – 35-45 mm Hg MANAGEMENT: Monitor=====
[[File:ETCO2_Normal.jpg|none|400px|]]

=====DISLODGED ETT: Loss of waveform, Loss of EtCO2 MANAGEMENT: Replace ETT=====
[[File:ETCO2_Dislodged.jpg|none|400px|]]

=====ESOPHAGEAL INTUBATION: Absence of waveform MANAGEMENT: Re-intubate=====
[[File:ETCO2_Esophageal.jpg|none|400px|]]

=====HYPOVENTILATION: ↓ RR, EtCO2 > 45 mm Hg MANAGEMENT: Assist ventilations/intubate=====
[[File:ETCO2_Hypoventilation.jpg|none|400px|]]

=====HYPERVENTILATION: ↑RR, EtCO2 < 35 mm Hg MANAGEMENT: ↓ventilations=====
[[File:ETCO2_Hyperventilation.jpg|none|400px|]]

=====BRONCHOSPASM: “Sharkfin” MANAGEMENT: Bronchodilators=====
[[File:ETCO2_Bronchospasm.jpg|none|400px|]]

[[Category:Procedure Guidelines|0913]]