Procedure 9 - Airway/Breathing: Capnography

With what invasive airway procedures shall capnography be used?

Endotracheal intubation, cricothyrotomy, or Blind Insertion Airway Devices (BIAD).

With what therapy is capnography used besides invasive airways?

CPAP.

What patient condition requires capnography for respiratory distress patients?

Any patient with respiratory distress that requires treatment by EMS.

What medication administration requires capnography monitoring?

Any patient receiving narcotics.

What device requires capnography monitoring besides narcotics administration?

Patients with a ventricular assist device.

To what devices can an inline capnography sensor be attached?

A King Tube, endotracheal tube, or bag-valve-mask (BVM).

When should a cannula-style capnography sensor be used?

With high-flow oxygen masks, hand-held nebulizers, and nasal cannulas.

When does a cannula-style sensor provide more accurate readings over a CPAP or BVM mask?

If a seal can be maintained over the small tubing.

What should be used if the CPAP or BVM mask leaks, and what is the caveat?

An inline sampler can be used instead, but carbon dioxide measurements may read artificially low.

What must be documented with each respiratory failure, cardiac arrest, or respiratory distress patient regarding capnography?

The exhaled carbon dioxide measurement and waveform changes.

How long should capnography devices remain in place and be monitored?

Throughout prehospital care and transport.

What does any loss of CO2 detection or waveform indicate?

An airway problem, which should be addressed immediately and documented.

When should capnography be monitored during procedures?

While procedures are performed, to verify or correct any airway problems.

What must be documented on the PCR regarding capnography?

The procedure and results.

What does a sudden loss of capnography waveform indicate?

ET tube disconnected, dislodged, kinked or obstructed, or loss of circulatory function.

What capnography waveform appearance indicates bronchospasm?

A "shark-fin" appearance.

What conditions cause a shark-fin bronchospasm waveform on capnography?

Asthma or COPD.

What can cause decreasing EtCO2 on capnography?

ET tube cuff leak, ET tube in the hypopharynx, or partial obstruction.

What minimum EtCO2 value should be maintained during CPR per capnography assessment?

A minimum of 10 mmHg.

What does a sudden increase in EtCO2 on capnography indicate?

Return of spontaneous circulation (ROSC).

What can cause decreased EtCO2 on capnography?

Apnea or sedation.

What provider levels can use capnography per CFD protocol?

EMT-B, EMT-A, and EMT-P.