ETCO2 Wave Forms

Question 1

Poss causes of RISING BASELINE (2)

Answer 1

Rebreathing CO2 (low O2 lpm in nrb?); Obstructed exhaust port

Question 2

Treatment RISING BASELINE

Answer 2

Increase O2; remove obstruction in exhaust; stop paper bag breathing

Question 3

Poss causes of SHARK FIN

Answer 3

Bronchoconstricion / spasm

Question 4

Shark Fin indicates respiratory ?

Answer 4

Distress

Question 5

Smooth muscle found around bronchioles? alveoli?

Answer 5

Bronchioles, yes - alveoli, no

Question 6

Poss causes of PROLONGED PHASE 4 (3)

Answer 6

Means CO2 coming out of mouth during inhalation; poss deflated ETT cuff; ETT too small in pedi

Question 7

Treatment PROLONGED PHASE 4

Answer 7

Extubate only if not effective (never use tube that is too small for pedi just b/c you are insecure!)

Question 8

How to determine ETT effectiveness?

Answer 8

Evaluate skin, Pulse Ox, and ETCO2

Question 9

Another name for NOTCHED ALVEOLAR PLATEAU?

Answer 9

Curare Cleft

Question 10

What is curare?

Answer 10

Paralytic.

Question 11

Curare Cleft / Notched plateau is a sign of what?

Answer 11

Sign to re-dose paralytic! (DO NOT forget sedative!) (Means diaphragmatic spasm)

Question 12

Other signs to re-dose paralytics in intubated patient?

Answer 12

Tears, inc HR, inc BP, gagging (BAD!)

Question 13

If suspect Pulmonary Embolus, what wave form is your nail in the coffin?

Answer 13

Curare Cleft / Notched Alveolar Plateau

Question 14

Poss causes of STAIR-STEP ALVEOLAR PLATEAU?

Answer 14

Dec pressure of expelled air (allows O2 to dilute); Tired of breathing; CPAP

Question 15

Treatment for STAIR STEP ALVEOLAR PLATEAU?

Answer 15

Monitor CPAP; bag or tube

Question 16

Poss causes of STEADILY INC ALVEOLAR PLATEAU?

Answer 16

Hypoventilation OR Increased metabolic rate

Question 17

Treatment of STEADILY INC ALVEOLAR PLATEAU?

Answer 17

Bag ‘em; O2

Question 18

Poss causes of STEADILY DEC ALVEOLAR PLATEAU?

Answer 18

Hyperventilation OR Decreasing metabolic rate

Question 19

Treatment of STEADILY DEC ALVEOLAR PLATEAU?

Answer 19

O2, BVM, Calming techniques, Sedatives

Question 20

Poss causes of SUDDEN DROP in ALVEOLAR PLATEAU?

Answer 20

Sudden drop in cardiac output.

Question 21

Treatment for SUDDEN DROP in ALVEOLAR PLATEAU?

Answer 21

Inc cardiac output! (vasopressors); check pulse, cpr, O2, shock trtmt, fluids

Question 22

Cause of sudden cessation of wave forms?

Answer 22

Apnea, no breathing, ETT dislodged (check placement, check tubing)

Question 23

ETT placement WITHOUT capnography = how long before you get feedback on effectiveness?

Answer 23

3-6 min!

Question 24

ETT placement WITH capnography = how long before you get feedback on effectiveness?

Answer 24

Immediate!

Question 25

Are these ETT placement indicators reliable: Chest rise, breath sounds, stomach sounds?

Answer 25

NO!

Question 26

What should you do before releasing pt care to ER?

Answer 26

PRINT YOUR WAVEFORM!!

Question 27

Poss causes of SUDDEN RISE in ALVEOLAR PLATEAU?

Answer 27

ROSC (check for pulse, may still be PEA) - similar to flooded car that finally cranks.. give it a few min to even out

Question 28

PEA trtmt?

Answer 28

CPR, push epi (constricts vessels)

Question 29

Determining death in field with capnography?

Answer 29

Square waves < 10 mmHg - if you are not hyperventilating, then pronounce dead in field.

Question 30

Anxiety Induced Hyperventilation s/s?

Answer 30

Square waves, but LOW; inc RR, inc Tidal Vol (i.e. blowing off all CO2)

Question 31

Saddle PE cause?

Answer 31

From quivering atria -> no pump -> stagnant blood -> clot

Question 32

What is a saddle PE?

Answer 32

Clot saddles pulmonary artery split (blocks blood flow to lungs) -> no oxygen coming back to lungs

Question 33

Saddle PE waveform and SPO2

Answer 33

Capnography LOW and DEC; SPO2 LOW and DEC