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.