EMS World

AUG 2011

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 42 of 71

CAPNOGRAPHY IN EMS the alveoli for exhalation. It also provides a graphic picture of the patient’s ventila- tory status, presents an early warning of changes in the patient’s cardiopulmonary status, supplies indisputable documenta- tion of the patient’s airway patency, and alerts clinicians to the presence of pulmo- nary pathology. Abnormal capnography values can be traced to diseases affecting ventilation, perfusion or metabolism. Continuous waveform capnography is recommended to EMS for verifi cation of endotracheal tube (ETT) placement.1 The 2010 ACLS guidelines have elevated the role of capnography to recommending continuous waveform CO2 monitoring during resuscitation. Capnography is can also provide valu- able cardiopulmonary information to assist paramedics in caring for non-intubated patients. Capnography & Intubated Patients Capnography provides a reliable and objective method to confi rm endotracheal intubation. The presence of a waveform demonstrates proper placement, even during CPR. This has been well docu- mented over the past few years.1,2 Capnography can also be useful in detecting a change in position of the endotracheal tube. In EMS, this is impor- tant, as the endotracheal tube may be accidentally displaced while moving the patient. Given some of the untoward and noisy environments where cardiac arrest occurs, confi rming ETT placement by lung sounds alone can be problematic and sometimes even deceiving, especially in smaller patients. A 2005 study compared prehospital intubations using continuous capnography to confi rm tube placement with those not using capnography. The group using capnography achieved correct tube placement in 100% of their patients. The group practicing without the benefi t of capnography had a misplaced tube (unrecognized esophageal or supraglottic) in 23% of their patients.1 Alternative Airways Recent studies have dulled the signifi - cance of endotracheal intubation, and many EMS providers are relying more   on alternative methods of securing the airway.3 Capnography is just as easily applied to alternative airways like the Combitube, King airway or laryngeal mask airway (LMA). As with the endotracheal tube, proper and improper ventilation can be monitored with alternative airways and corrected where necessary. It is imperative to ensure the device is providing suffi cient protection of the airway to allow effective rescuer ventilation.4 The capnography waveform assists in determining proper ventilation with any device that securely attaches to a bag- valve mask. No matter which device is in use, capnography can provide immediate EMERGENCY MEDICAL SCIENCE ONLINE DEGREE PROGRAM E ARN YOUR DEGREE ONLINE  6WDWH DQG 1DWLRQDO 3DUDPHGLFV HDUQ XS WR FUHGLWV WRZDUG DQ (PHUJHQF\ 0HGLFDO 6FLHQFH 'HJUHH IRU \RXU FXUUHQW FHUWL¿FDWLRQ 'HJUHH FODVVHV IRU FHUWL¿HG SDUDPHGLFV WRWDOO\ RQOLQH QR RQVLWH UHTXLUHPHQWV UHJLVWUDWLRQ DQG DGPLQLVWUDWLRQ FRPSOHWHG E\ SKRQH ID[ RU HPDLO 'HJUHH SURJUDP LV GHVLJQHG IRU GHPDQGLQJ (06 ZRUN VFKHGXOHV &RPSOHWH WKH GHJUHH DW \RXU RZQ SDFH PARAMEDIC CERTIFICATION ONLINE (HYBRID  PROGRAM) 7KLV +\EULG 3URJUDP LV RIIHUHG WR LQGLYLGXDOV ZLWKRXW DQ\ (06 WUDLQLQJ $OVR DYDLODEOH IRU FXUUHQW EDVLF RU DGYDQFHG (07V VHHNLQJ 3DUDPHGLF FHUWL¿FDWLRQ  3URJUDP RIIHUHG WKURXJK /&& &RQWLQXLQJ (GXFDWLRQ 'HSDUWPHQW 2QO\ IRXU RQ VLWH YLVLWV IRU VNLOOV WUDLQLQJ DQG HYDOXDWLRQV DOO FODVVZRUN GRQH RQOLQH 7XLWLRQ LV RQO\ &RQWDFW D SURJUDP VSHFLDOLVW DW H[W +Z\ 6RXWK  .LQVWRQ 1&  ZZZ OHQRLUFF HGX For More Information Circle 42 on Reader Service Card EMSWORLD.com | AUGUST 2011 39

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