By J. S. Gravenstein, Michael B. Jaffe, David A. Paulus
Lately capnography has won a foothold within the clinical box and is quickly changing into a customary of care in anaesthesiology and important care medication. additionally, more moderen functions have emerged that have extended the software of capnographs in a few scientific disciplines. This new version of the definitive textual content on capnography studies each element of this beneficial diagnostic strategy. An introductory part summarises the fundamental body structure of carbon dioxide iteration and delivery within the physique. A technical part describes how the tools paintings, and a complete medical part stories using capnography to diagnose a variety of scientific problems. Edited by means of the area specialists within the strategy, and with over forty expert participants, Capnography, moment version, is the main entire overview to be had at the program of capnography in health and wellbeing care.
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Additional info for Capnography
Vukmir RB, Heller MB, Stein KL. Confirmation of endotracheal tube placement:Â€a miniaturized infrared qualitative CO2 detector. Ann Emerg Med 1991; 20:Â€726–9. 46. Knapp S, Kofler J, Stoiser B, et al. The assessment of four different methods to verify tracheal tube placement in the critical care setting. Anesth Analg 1999; 88:Â€776–80. 47. Hayden SR, Sciammarella J, Viccello P, Thode H, Delagi R. Colorimetric end-tidal CO2 detection for verification of endotracheal tube placement in out-of-hospital cardiac arrest.
Capnography is shown to be the most useful modality for determining tube location, both with and without cardiac arrest. ) The use of capnography for OOH airway management enhances patient safety and can prevent the problem of UMI and should be a mandatory component of OOH airway management. e. , flatline), remove the ET, and proceed to the next step in the algorithm Briefly check filter-line coupling to assure it is securely in place Contact Medical Control for any additional orders or questions Bag-mask ventilate (BVM)1 Goal is to keep oxygen saturation ≥ 90 for 1-2 min preattempt when possible Endotracheal Intubation (ET) or Laryngeal Tube Airway (LTA)2 ET or LTA • Only 2 attempts (per device) for medical, 1 attempt (per device) for trauma • Attempt to bag-mask ventilate between attempts • Stop any attempt if 30 s pass or significant drop in oxygen saturation Confirm with ETCO2 and Exam Unsuccessful Resume BVM1 and expedite transport Monitor ETCO2, oxygen saturation and assess for effective ventilation2 As a last resort, if unable to ventilate by any means, consider cricothyrotomy 28 Successful Continue ventilation3 and monitoring 1.
Endotracheal intubation Capnographic confirmation Waveform present Waveform flatline Tracheal placement • Check tube depth • Check breath sounds • Secure tube • Ventilation Continuous ETCO2 monitoring Assess patient condition Arrest Non-arrest Clinical discretion Non-tracheal tube Auscultation method* Remove tube Positive Tracheal tube Negative Non-tracheal tube cardiac arrest and resuscitation has been verified in both animal and human models [48,53]. If the proper waveform is present, regardless of its amplitude, tube placement can be confidently judged to be correct, although endobronchial intubation cannot be differentiated from endotracheal [25,54].