Increasing EtCO 2 Level Leak Muscle Relaxants (Curare Cleft) Esophageal Intubation Possible Causes: • ET tube cuff may be deflated or ruptured • ET tube in the vocal cords • Mask or Bag Mask Valve leak • Artificial airway is too small for patient Observations: • EtCO 2 drops during cardiac arrest • As rescuer tires, a decrease in EtCO 2 is observed • Increases with effective chest compressions and heart function Possible Causes: • Patient is mechanically ventilated Observations: • Depth of cleft is proportional to degree of drug activity Possible Causes: • Decrease in respiratory rate and/or tidal volume (hypoventilation) • Increase in metabolic rate • Rapid rise in body temperature (malignant hyperthermia) EtCO 2 During Cardiac Arrest Observations: • No CO 2 sensed • Small transient waveforms END-TIDAL CO 2 Normal and Abnormal Capnogram Waveforms Time Time Time Time Time Time Time Time Time Time Time Time Time Time Time Time Time Time Real-Time Trend Curare Cleft Time Time Real-Time Trend Curare Cleft Normal Capnogram Waveform Indications: • ET tube is correctly positioned • Proper ventilation is occurring A-B: Baseline B-C: Expiratory Upstroke C-D: Expiratory Plateau D: End-tidal Concentration D-E: Inspiration EtCO 2 increases significantly with the return of effective heart function. Rebreathing Time Time Time Time Time Time Time Time Possible Causes: • Mechanical dead space • Mechanical ventilator failure Abnormal Capnogram Waveforms Time Time Time Time Time Time Time Time Possible Causes: • Increase in respiratory rate and/or tidal volume (hyperventilation) • Decrease in metabolic rate • Fall in body temperature Decreasing EtCO 2 Level Airway Obstruction Time Time Time Time Time Time Time Time Possible Causes: • Partially kinked or occluded artificial airway • Presence of foreign body in the airway • Bronchospasm - Elevated end-tidal CO 2 valve - Loss of alveolar plateau
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Increasing EtCO2 Level
Leak
Muscle Relaxants (Curare Cleft)
Esophageal Intubation
Possible Causes:• ET tube cuff
may be deflated or ruptured
• ET tube in the vocal cords
• Mask or Bag MaskValve leak
• Artificial airway istoo small for patient
Observations:• EtCO2 drops during cardiac arrest• As rescuer tires, a decrease in
EtCO2 is observed• Increases with effective chest
compressions and heart function
Possible Causes:• Patient is mechanically ventilated
Observations:• Depth of cleft is proportional to degree
of drug activity
Possible Causes:• Decrease in
respiratory rate and/or tidal volume(hypoventilation)
• Increase inmetabolic rate
• Rapid rise in body temperature (malignant hyperthermia)
EtCO2 During Cardiac Arrest
Observations:• No CO2 sensed• Small transient waveforms
CMYK
END-TIDAL CO2Normal and Abnormal Capnogram Waveforms
TimeTimeTimeTimeTimeTimeTimeTime
TimeTimeTimeTimeTimeTimeTimeTime
TimeTime
Real-Time TrendCurare Cleft
TimeTime
Real-Time TrendCurare Cleft
Normal Capnogram Waveform
Indications:• ET tube is correctly positioned• Proper ventilation is occurring
A-B: BaselineB-C: Expiratory UpstrokeC-D: Expiratory PlateauD: End-tidal ConcentrationD-E: Inspiration
EtCO2 increases significantly with the return of effective heart function.
Rebreathing
TimeTimeTimeTimeTimeTimeTimeTime
Possible Causes:• Mechanical dead space• Mechanical ventilator failure
Abnormal Capnogram Waveforms
TimeTimeTimeTimeTimeTimeTimeTime
Possible Causes:• Increase in
respiratory rate and/or tidal volume(hyperventilation)
• Decrease inmetabolic rate
• Fall in bodytemperature
Decreasing EtCO2 Level
Airway Obstruction
TimeTimeTimeTimeTimeTimeTimeTime
Possible Causes:• Partially kinked or occluded artificial airway• Presence of foreign body in the airway• Bronchospasm
- Elevated end-tidal CO2 valve- Loss of alveolar plateau
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