End Tidal CO2 Monitoring and Capnography

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Procedure Guidelines

9.13 END TIDAL CO2 MONITORING CAPNOGRAPHY

INDICATIONS:

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,
seizure, CHF, shock & circulatory compromise

CPR: compression efficacy, early sign of ROSC,
survival predictor*
Hyperventilation: DKA, metabolic acidosis,
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
ETCO2 Normal.jpg
DISLODGED ETT: Loss of waveform, Loss of EtCO2 MANAGEMENT: Replace ETT
ETCO2 Dislodged.jpg
ESOPHAGEAL INTUBATION: Absence of waveform MANAGEMENT: Re-intubate
ETCO2 Esophageal.jpg
HYPOVENTILATION: ↓ RR, EtCO2 > 45 mm Hg MANAGEMENT: Assist ventilations/intubate
ETCO2 Hypoventilation.jpg
HYPERVENTILATION: ↑RR, EtCO2 < 35 mm Hg MANAGEMENT: ↓ventilations
ETCO2 Hyperventilation.jpg
BRONCHOSPASM: “Sharkfin” MANAGEMENT: Bronchodilators
ETCO2 Bronchospasm.jpg