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 44 of 71

CAPNOGRAPHY IN EMS Capnography waveform examples. Left: Intubated patient; right: non-intubated patient. fi nning cannot be “faked” (see Figure 1). By analyzing the CO2 waveform over Courtesy of Physio-Control, Inc. rate and/or blood pressure. Patients with acute obstructive disease processes of the lung (asthma, COPD, bronchitis) may be identifi ed using EtCO2 monitoring. These patients, all of whom may experience bronchospasm in the lungs, can be identifi ed by a unique characteristic change seen in the EtCO2 waveform. Bronchospasm will produce a “shark fi n” capnography waveform due to diffi culty emptying alveoli.12 The char- acteristic shark fi n appearance is a result of regional obstruction, which causes a turbulent mixing of dead space air with alveolar air. This mixing softens the rapid rise in CO2 time, the paramedic can monitor the severity of asthma or chronic obstructive pulmonary disease (COPD) and the effec- tiveness of therapy provided. Capnogram analysis may be used to indicate airway obstruction in these patients, but further work is required to correlate curve indices to the degree of airway obstruction.11 Carbon dioxide values in asthma will change depending on severity of the disease. Hyperventilation may occur early in an acute asthma attack, lowering EtCO2 levels with a slightly abnormal waveform. As the attack progresses, the EtCO2 may concentration of exhaled air. It is important to note that the shark fi n appearance of the capnograph has a direct physiological cause and is characteristic of bronchospasm. In other words, shark- read in the normal range, with a more prominent looking shark fi n waveform on the monitor. Finally, as the attack becomes severe, the EtCO2 rises and the wave becomes indistinguishable in its shark fi n form. Once treatment is decided upon and the bronchoconstriction decreases, the EtCO2 number may increase initially Get Free – Get Firecom. Proven hands-free wireless crew communications. www.firecom.com • 800-527-0555 • sales@firecom.com For More Information Circle 43 on Reader Service Card See Us at EMS Expo Booth #2321 and FRI Booth #1942 EMSWORLD.com | AUGUST 2011 41

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