Medical Training - Monitoring - For internal use only.

Medical Training- Monitoring -

For internal use only

2

Objective of Presentation

• This presentation on Monitoring gives the reader an overview of current systems which can be used to monitor mechanical ventilation. It covers medical fundamentals and recognition of life-threatening situations.

• The reader will also become acquainted with the different priorities of alarms on MEDUMAT Transport.

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008

© WEINMANN GERÄTE FÜR MEDIZIN GMBH+CO.KG, Medical Training - Monitoring, June 2008 3

Contents

• Ventilation Monitoring• Pressure/Volume Curve• Capnometry /Capnography• MEDUMAT Transport Alarms


Ventilation MonitoringEvery use of mechanical ventilation has to be monitored continuously as a check of its effectiveness and success. In addition to oxygen saturation -- the ‘sign of success’ – other measures are required for the assessment and management of the ventilation process. The following parameters can be used in an evaluation:

–Clinic–Capnometry–Expiration volumetry–Ventilation pressures–(Blood Gas Analysis)

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Important Parameters For Assessing the Quality of Ventilation

• Measurements:– Tidal volume– Respiratory Minute Volume– Respiratory rate– Maximum pressure– PEEP level

– etCO2

• Curves– Flow curve– Pressure curve– Capnography



Pressure Curve• Composition of Pressure/Time Diagram


Flow Curve• Composition Flow/Time Diagram


Capnometry /Capnography

• Non-invasive continuous monitoring of CO2 portion of exhaled air

– Check position of tube

– Check ventilation

– Check circulatory function

• Sensitive monitoring process• Two different reporting means

– capnometry (numeric value)

– capnography (curve)

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Structure of CO2 Curve in Capnogram

I. Inspiration

II. CO2 of upper airways (dead space)

III. CO2 of lower airways (alveoli)

IV. Start of next inspiration


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Functional Principle of etCO2 Measurement

• Infrared spectroscopy with wave length of 426 nm • Absorption of light proportional to number of available

CO2 gas molecules


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Interpretation of CO2 Curves• Exponential decrease in PCO2

– Cardiac arrest– Pulmonary embolism– Sudden decrease in blood pressure

• Constant low etCO2– Absolute hyperventilation – Low body temperature– Centralization of shock

• Constant high etCO2– Hypoventilation

• Sudden decrease in etCO2– Accidental extubation– Faulty esophageal intubation– Disconnection

• Slant in etCO2 plateau– Bronchospasms (e.g., asthma)



Influences on etCO2 Level

In patients depending on:

– Circulatory function and CO2 transport to lungs

– Metabolism at cellular level

– Ventilation for respiratory elimination of CO2


Normal Capnometry /Capnography

– etCO2 in patient with normoventilation

• 4-5 Vol% = 30-35 mm Hg– Conversion:

• 1 Vol% = 7 mmHg• 1 mmHg = 0.15 Vol%


Alarms

• Distinction between physiological and system alarms in MEDUMAT Transport

• Graduated in three (3) alarm escalation levels• Requires individual adjustment for each patient


Alarm – High Priority

• Tidal volume high/low• Respiratory Minute Volume high/low• Apnea• Leak on patient side of device• Expiratory CO2 high/low• Inspiratory CO2 high• Airway pressure high/low• Oxygen supply low


Alarms – Medium Priority

• Respiratory rate high• Oxygen concentration high

• CO2 Occlusion


Alarm – Low Priority

• CO2 module defective


Summary

• Every ventilation of a patient requires that thorough checks be made of the ventilation settings by measuring physiological parameters.

• Knowing the etCO2 numerical values and curves gives the user a greater degree of safety and certainty during ventilation of emergency patients.

• Device-specific alarms in three different priority levels indicate problems or danger.

Medical Training - Monitoring - For internal use only.

Documents

medical training monitoring

patient slide

occlusion slide

medical fundamentals

ventilation process

module defective slide

ventilation settings

cellular level ventilation