![]() Boom, baby! We have lift off! Yep, assess the patient. We’re working our full arrest, we’re working our full arrest, and suddenly our end-tidal spikes to over 40. If during chest compressions we notice that our end-tidal reading is at 10 or below, we need to improve the chest compressions we’re doing.Īnother great benefit to continuous end-tidal monitoring during a cardiac arrest is to assess for the return of spontaneous circulation. We’re looking at the patient’s respiratory rate and all this upward deflection is exhalation by the patient.ĭuring a cardiac arrest, it’s our goal to achieve an end-tidal reading of at least 10 mmHg (or above 10 mmHg). Again, moving from left to right horizontally, that’s the measurement of time. You can see how the waveform has become shorter because the patient is taking less time to exhale. To demonstrate this, let’s say the patient’s respiratory rate goes from 20 to 50. ![]() Moving horizontally from left to right, when we’re looking at this waveform, that’s the measurement of time: how fast is the patient breathing. That’s the amount of exhaled CO2 during that one exhaled breath or exhaled end-tidal volume. It ends and they begin to take a breath, so this is their end-tidal exhalation and that’s where we’re getting that number from. We can see that they’re exhaling the tidal volume and exhaling the tidal volume. Now the patient’s going to exhale all this tidal volume. Whether they take the breath in or we’re giving them the breath, that’s the tidal volume, the amount of air that’s going in during one breath. Remember, the one breath of air, the amount of air that a patient takes in during one breath is called the tidal volume. Where are we actually getting this end-tidal number from? It’s the end-tidal. Then it plateaus and levels off, and where it ends and drops is the beginning of the patient’s next inspiratory effort. The patient starts to exhale-they’re starting to blow off CO2-and we can see this waveform start to rise. This upward inflection we’re seeing here first is the patient exhaling. ![]() Remember, we’re talking about the patient’s exhaled CO2. It can also help determine the effectiveness of the chest compressions I’m doing if the heart fails.īefore we get into these numbers, let’s take a quick look at a capnography waveform and define the parts in the waveform. However, in ACLS and in a cardiac arrest, I’m using end-tidal not necessarily for the pulmonary or respiratory status but to look at the function of the pump, the function of the heart. I can look at those numbers and adjust my ventilator accordingly to keep them within a normal range. Remember, a normal end-tidal is between 35 and 45. I’m using it for respiratory and pulmonary status. Usually in the field, I’m using end-tidal to tweak my ventilator. Remember, the cells are going to use this oxygen, create the CO2, but I still have to have adequate cardiac output, a working pump, to pump that CO2 all the way back to the lungs so it can be exhaled and measured. This is exactly what we’re using end-tidal CO2 for in ACLS. By evaluating the exhaust, they can see if there’s a problem with the motor. If you get a notice from your emissions center like I just got, I’m going to take my van in and have the emissions center check my exhaust. The motor uses the gas and then kicks out exhaust. I kind of think of it like the exhaust in a car. ![]() What is end-tidal capnography? It’s a quantitative measurement of a patient’s exhaled CO2, which is the byproduct of cellular metabolism. In today’s video presentation, we’re going to talk about end-tidal capnography-how we use it in ACLS and especially during a cardiac arrest. I’m Mark from ACLS Certification Institute. ![]()
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