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 46 of 71

CAPNOGRAPHY IN EMS the end of its “cycle.” If capnography indicates that a patient’s ventila- tory status is suffi cient, then only supportive measures are required.15 Patient Management Based on Capnography To properly assess ventilation, it is important to understand what determines respiration and venti- lation in the human body. Factors such as metabolic rate, acid-base status, central CO2 respiratory drive, physiologic dead space and lung mechanics all play a role. There are factors that increase ventilatory demand, such as arte- rial hypoxemia, increased meta- bolic rate, increased physiologic dead space, metabolic acidosis, pulmonary edema, increased work of breathing, confusion and central nervous system stimula- tion. Changes in any of the latter factors affect EtCO2 . Waveform capnography provides further insight into caring for your patient in many clinical states and is a tool paramedics should not be without. Table 1 lists some of the causes of both increased and decreased CO2 . Conclusion Capnography has a clinical utility in EMS with many types of disease states. It assists the EMS provider in measuring and moni- toring metabolism, circulation and ventilation. Used with pulse oxim- etry, it provides insight into the management of many emergen- cies involving the pulmonary and circulatory systems. This includes not only respiratory compromise but factors also affecting perfusion and metabolism. The capnography waveform is a key vital sign when determining treatment for patients in the fi eld. Capnography sampling devices are useful in all types of airways, whether or not the patient is intubated. REFERENCES 1. Silvestri S, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med 497–503, May 2005. 2. The American Heart Association: Highlights of the 2010 AHA Guidelines for CPR and ECC, http://static.heart.org/ eccguidelines/pdf/90-1043_ECC_2010_ Guidelines_Highlights_noRecycle.pdf. 3. Egly J, Custodio D, Bishop N, et al. Assessing the impact of prehospital intubation on survival in out-of-hospital cardiac arrest. Prehosp Emerg Care 15:44–49, 2011. 4. Kette F, Reffo I, Giordani G, et al. The use of laryngeal tube by nurses in out- of-hospital emergencies: Preliminary experience. Resuscitation 66:21–25, 2005. 5. Berg RA, Henry C, Otto CW, et al. Initial end-tidal CO2 cardiopulmonary resuscitation after asphyxial cardiac arrest. Pediatr Emerg Care 12:245–248, 1996. 6. Falk JL, Rackow EC, Weil MH. End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. N Engl J Med 318:607–611, 1988. 7. Ornato JP, Garnett AR, Glauser FL. Relationship between cardiac output and the end-tidal carbon dioxide tension. Ann Emerg Med 19:1104–1106,1990. 8. Ward K, Yealy D. End-tidal carbon dioxide monitoring in emergency medicine: Part 2: Clinical applications. Acad Emerg Med 5:637–646, 1998. 9. Levine RL, Wayne MA, Miller CC. End- tidal carbon dioxide and outcome of out- of-hospital cardiac arrest. N Engl J Med 337:301–306, 1997. 10. Seppelt I. Intracranial hypertension after traumatic brain injury. Indian J Crit Care Med 8:120–126, 2004. 11. You B, Peslin R, Duvivier C, et al. Expiratory capnography in asthma. Eur Respir J 7:318–323, 1994. 12. Burton JH, Harrah JD, Gremann CA, Dillion DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices. Acad Emerg Med 13:500–504, 2006. 13. Swedlow DB. Capnometry and capnography: The anesthesia disaster early warning system. Seminars in Anesthesia 3:194–205, 1986. 14. Fearon DM, Steele DW. End-tidal carbon dioxide predicts the presence and severity of acidosis in children with diabetes. Acad Emerg Med 9:1373–1378, 2002. 15. Krauss B. Advances in the use of capnography for nonintubated patients. Israeli J Emerg Med 8:3–15, 2008. 16. Nagler J, Krauss B. Capnographic monitoring in respiratory emergencies. Clin Ped Emerg Med 10:82–89, 2009. David Wampler, PhD, LP, is an assis- tant professor of Emergency Health Sciences, University of Texas Health Science Center, San Antonio, He is also a member of EMS World Magazine’s editorial advisory board. is markedly elevated during Coming Fall 2011 Our new and improved buyEMP.com website! We are excited to announce that the buyEMP.com website will be better than ever! Check it out and you will fi nd: t &91"/%&% 1SPEVDU *OGPSNBUJPO t &/)"/$&% 1SPEVDU 4FMFDUJPO t '"45&3 $BUBMPH 2VJDL 0SEFS t *.1307&% $IFDLPVU 1SPDFTT t */5&3"$5*7& 4IPQQJOH $BSU t 61(3"%&% 4FBSDI $BQBCJMJUJFT t #&45 0' "--yUIF TBNF HSFBU TFSWJDF and selection that you have come to ex- QFDU GSPN &NFSHFODZ .FEJDBM 1SPEVDUT TX. Order your EMP 2012 Catalog today! 800.558.6270 For More Information Circle 44 on Reader Service Card See Us at EMS Expo Booth #3821 EMSWORLD.com | AUGUST 2011 43

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