End Tidal CO2 Monitoring / Capnography

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

DISLODGED ETT: Loss of waveform, Loss of EtCO2 MANAGEMENT: Replace ETT

ESOPHAGEAL INTUBATION: Absence of waveform MANAGEMENT: Re-intubate

HYPOVENTILATION: ↓ RR, EtCO2 > 45 mm Hg MANAGEMENT: Assist ventilations/intubate

HYPERVENTILATION: ↑RR, EtCO2 < 35 mm Hg MANAGEMENT: ↓ventilations

BRONCHOSPASM: “Sharkfin” MANAGEMENT: Bronchodilators