May 2006

Hi, everyone.

I am using this blog to explore the issue of capnography in the prehospital setting. Unlike with 12-Lead ECGs, you can't just go out and buy a book. The information on capnography is out there, but not that accessible. I want to use this site to gather that information into one place, as well as to post my own experiences.

I first heard about capnography at the JEMS conference in Philadelphia a few years ago. I took a one hour mini-class from a vendor. In one ear and out the other. I didn’t have capnography so it didn’t stick. Last year, we finally got capnography put on our Life Pack 12s. I learned how to put it on the ET tube, but the first couple codes I did, I completely forgot that I had it, then the next couple times I remembered about ten minutes into the code. Now, I keep an ET filter line in my airway kit, so it is starring at me when I unzip the kit.

The first code I used the End Tidal Monitoring on, I was alarmed that I didn’t get much of a wave form and that my capnography number was so low. (See Compressions). Later I did a call where the patient initailly looked so dead, I thought she was going to have rigor when I touched her, I popped the filter line on and was startled, after a few minutes of CPR, to suddenly see an End Tidal number of 35 (See A Blanket). A short time we got pulses back and then later the patient began breathing on her own. I have learned that capnography can be a predictor of rescuitation chances.

Most of all a good capnography wave insures that the tube is in the trachea where its supposed to be and not in the esophagus which would produce a flat line, immediately on the capnography wave form and eventually on the heart monitor as well if the tube is not moved to the right place.

In April 2006 I took a really good class on capnography, taught by Gary Childs of the Mercy Hospital Education Center.

Part of the class covered capnography for the non-intubated patient, which was the main reason I took the class. Instead of an attachment on an ET tube, a nasal cannula-like monitoring device was put on the patient. We were taught that the shape of the wave form changed depending on the problem. Asthmatics and COPDers had a characteristic shark fin shape, which indicated resistance to expiration.

I am hooked on using capnography now, and every time I use it, it seems I learn something new.

Here is the outline I am going to try to use for this blog

1. What's New?

A dated list of all new additions to the blog in recent days.

2. 10 Things Every Paramedic Should Know About Capnography

This is a document in-progress. I may at some point do a companion piece -- Another Ten Things Every Paramedic Should Know About Capnography, but that will have to wait until I learn another Ten Things.

3. Capnography News

The latest on capnography

4. Web Resources

The best capnography links on the web -- that I know about anyway.

5. Clinical Studies

I will try to summarize or at least list the Abstracts of the best studies on capnography in EMS.

6. Capnography: Clinical Issues: Text Book

I will provide my notes from the only up-to-date Capnography textbook currently available.

7. Case Studies

These will be interesting cases I have had.

8. Monthly Capnography Logs

A record on my daily use of capnography and what I am learning. I will archive this section every month.

Because I am still a novice at it, I don't claim that my interpretations will be 100% accurate. If I am wrong or off-base or you can add something to my understanding, please feel free to comment. Also, any links to other capnography sites would be appreciated.




At 7:24 AM, Blogger Randy said...

Dear PC,

I am one of the product managers for Respironics/Novametrix and I am contacting you to let you know of a web based capnography training program that we have. It is approved by the Continuing Education Coordinating Board of Emergency Medicine Services, for 1.0 Advanced CEH. This is a free service that we provide. We also have this program and others for RT's and RN's. The web link is http://elearning.respironics.com. Please call me if you get a chance, as we have other training material available. We also have educational material on our web site www.oem.respironics.com.

Randy Terry

At 7:11 PM, Blogger P said...

I'll call you later this week. I will look into the CME and will post your site when a get a moment later in the week.

Thanks for the info,


At 5:23 PM, Blogger garys said...

Interesting blog. I'm a big fan of Capnography and have managed to get some other medics at work interested in doing more than using it on dead people to confirm tube placement.

Capnography is the tool that Pulse Ox is alleged to be.

I've just started to explore the blog and don't know if you've discussed differentiating COPD from CHF. I've done this a couple of times by looking at the CO2 level and the waveform.

I just posted a link to the blog on a paramedicine email list, so you will hopefully see an uptick in visits.


At 6:43 PM, Blogger P said...


Thanks for posting the link on the paramedic email list. I do talk some about the CHF/COPD in the February and March blogs. I describe a case where i thought the waveform was saying the problem was CHF, not COPD, but had trouble convincing the noncapnography lingual ED. When I was down at the JEMS conference, I asked Bob Page, a capnography expert about it and he agreed with you, the wave form is very useful in distinguishing between the two diseases.

Thanks again,


At 8:00 PM, Blogger BC Medic said...

I stumbled upon your website while doing research for Capnography class for our medics. Then I saw that you were gracious enough to allow others to use yours. It is a kind gesture.(not many of those these days) I was bored one day and didn't want to sit in the recliner and play Halo all day, so I put your article in a powerpoint. I included the case studies from Oridion and Bob Page's download website. I would be glad to send it to anyone with your approval first. Please contact me if you would like to look at it. bcfdffmedic@earthlink.net
Thanks for the great info,
BC Medic

At 8:55 AM, Anonymous Anonymous said...

Great site. Thanks for the links. I utilize them often and refer many to this post. It has allowed my fire department to grow in this area. Keep up the good job

Warren Schneider NREMT-P
Phoenix Fire Department

At 9:01 PM, Anonymous Anonymous said...

"Capnography is the tool that Pulse Ox is alleged to be." (Gary)

Not exactly. It is important to remember what each tool is measuring.

The pulse oximeter measures the percent saturation of the hemoglobin (lets assume it is saturated by oxygen) which gives us a window into oxygenation, which capnography cannot do.

Capnography on the other hand provides us with information regarding both perfusion and ventilation, which pulse oximetry cannot do.

In other words each used alone gives us one half of the information, but when used together we get the entire picture of ventilation, perfusion, and oxygenation.

Consider this example. Your patient has an O2 sat of 100%. All you know is the hemoglobin is 100% saturated (with something), but you cannot definitively say what that something is, what the body is doing with it, or if it is even reaching the cells. You would get the same reading if the patient had one hemoglobin molecule that was saturated, but obviously this would not support metabolic functions.

But now suppose they also have an end tidal CO2 of 40. Now you know that the 100% is [most likely] oxygen, it is reaching the cells (perfusion is taking place), and metabolism is occurring. If these two factors were not present CO2 would not be produced. You also know the patient is ventilating well as they are exhaling the CO2 that was produced in the Kreb's cycle.

It is important to remember that while each tool is valuable one does not replace the other. Using both appropriately gives a much more complete picture of the patient that either one alone.

At 11:59 PM, Anonymous Anonymous said...

Cheers for the great site, I was just having a look on the net to learn more about capnography.

This site has proved useful. I hove found since I have started using capnography I want to do it more. Its utility in confirming ETT placement or indicating ROSC in cardiac arrest cannot be under stated. My recent limited study and experience has been in its use in TBI to avoid over oxygenation or hypercapnia.

Keep up the good work

At 12:01 PM, Anonymous Anonymous said...

Hi Peter,

Just stumbled onto your site and wished I'd found it earlier. Thanks for providing such a great resource! I'm working my way thru the material and noticed when I tried to access the capnography interpretations link to Bio Tel? it died. Is that no longer available? Thanks! Patrick


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