ETCO2 Wave Forms Flashcards
Poss causes of RISING BASELINE (2)
Rebreathing CO2 (low O2 lpm in nrb?); Obstructed exhaust port
Treatment RISING BASELINE
Increase O2; remove obstruction in exhaust; stop paper bag breathing
Poss causes of SHARK FIN
Bronchoconstricion / spasm
Shark Fin indicates respiratory ?
Distress
Smooth muscle found around bronchioles? alveoli?
Bronchioles, yes - alveoli, no
Poss causes of PROLONGED PHASE 4 (3)
Means CO2 coming out of mouth during inhalation; poss deflated ETT cuff; ETT too small in pedi
Treatment PROLONGED PHASE 4
Extubate only if not effective (never use tube that is too small for pedi just b/c you are insecure!)
How to determine ETT effectiveness?
Evaluate skin, Pulse Ox, and ETCO2
Another name for NOTCHED ALVEOLAR PLATEAU?
Curare Cleft
What is curare?
Paralytic.
Curare Cleft / Notched plateau is a sign of what?
Sign to re-dose paralytic! (DO NOT forget sedative!) (Means diaphragmatic spasm)
Other signs to re-dose paralytics in intubated patient?
Tears, inc HR, inc BP, gagging (BAD!)
If suspect Pulmonary Embolus, what wave form is your nail in the coffin?
Curare Cleft / Notched Alveolar Plateau
Poss causes of STAIR-STEP ALVEOLAR PLATEAU?
Dec pressure of expelled air (allows O2 to dilute); Tired of breathing; CPAP
Treatment for STAIR STEP ALVEOLAR PLATEAU?
Monitor CPAP; bag or tube
Poss causes of STEADILY INC ALVEOLAR PLATEAU?
Hypoventilation OR Increased metabolic rate
Treatment of STEADILY INC ALVEOLAR PLATEAU?
Bag ‘em; O2
Poss causes of STEADILY DEC ALVEOLAR PLATEAU?
Hyperventilation OR Decreasing metabolic rate
Treatment of STEADILY DEC ALVEOLAR PLATEAU?
O2, BVM, Calming techniques, Sedatives
Poss causes of SUDDEN DROP in ALVEOLAR PLATEAU?
Sudden drop in cardiac output.
Treatment for SUDDEN DROP in ALVEOLAR PLATEAU?
Inc cardiac output! (vasopressors); check pulse, cpr, O2, shock trtmt, fluids
Cause of sudden cessation of wave forms?
Apnea, no breathing, ETT dislodged (check placement, check tubing)
ETT placement WITHOUT capnography = how long before you get feedback on effectiveness?
3-6 min!
ETT placement WITH capnography = how long before you get feedback on effectiveness?
Immediate!
Are these ETT placement indicators reliable: Chest rise, breath sounds, stomach sounds?
NO!
What should you do before releasing pt care to ER?
PRINT YOUR WAVEFORM!!
Poss causes of SUDDEN RISE in ALVEOLAR PLATEAU?
ROSC (check for pulse, may still be PEA) - similar to flooded car that finally cranks.. give it a few min to even out
PEA trtmt?
CPR, push epi (constricts vessels)
Determining death in field with capnography?
Square waves < 10 mmHg - if you are not hyperventilating, then pronounce dead in field.
Anxiety Induced Hyperventilation s/s?
Square waves, but LOW; inc RR, inc Tidal Vol (i.e. blowing off all CO2)
Saddle PE cause?
From quivering atria -> no pump -> stagnant blood -> clot
What is a saddle PE?
Clot saddles pulmonary artery split (blocks blood flow to lungs) -> no oxygen coming back to lungs
Saddle PE waveform and SPO2
Capnography LOW and DEC; SPO2 LOW and DEC
