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This portable and practical pocket guide explains how capnography works both physiologically and electronically and helps clinical staff to apply the tool promptly and correctly, and to interpret appropriately the numeric and graphic displays, providing vital information when viewed in the context of the patient’s clinical presentation, history, and other diagnostic data that will improve and enhance care. Initial chapters explain how to interpret the data displayed in the context of various conditions, and how the care provider may respond to that data. Later chapters provide partial differential diagnoses based on the displayed capnometry data, an algorithm for interpreting waveforms, and clinical scenarios to illustrate the application of capnography in emergency medical practice. Ensuring that the value of capnography can be maximized to the benefit of patients, the book is an essential primer to capnography for those studying for and practicing within the emergency medical services, and a convenient reference for other emergency department personnel.
In recent years capnography has gained a foothold in the medical field and is fast becoming a standard of care in anaesthesiology and critical care medicine. In addition, newer applications have emerged which have expanded the utility of capnographs in a number of medical disciplines. This new edition of the definitive text on capnography reviews every aspect of this valuable diagnostic technique. An introductory section summarises the basic physiology of carbon dioxide generation and transport in the body. A technical section describes how the instruments work, and a comprehensive clinical section reviews the use of capnography to diagnose a wide range of clinical disorders. Edited by the world experts in the technique, and with over 40 specialist contributors, Capnography, second edition, is the most comprehensive review available on the application of capnography in health care.
Many providers don't understand the critical information provided by today's capnography. Because of a lack of understanding, this important technology is underutilized for basic information like determining if an endotracheal intubation is patent or not. This text will provide in-depth information, explained in basic and simple language so even a novice can learn the power of this important assessment tool by applying the information it provides to determine if the patient is sick or not sick. To understand the entire process of capnography a student must also understand how and why carbon dioxide is produced by the body. Without this basic understanding it would be difficult to comprehend why the presentation of higher concentrations or lower concentration of CO2 can help in determining if a patient is sick or not sick. Abnormal reading can guide a diagnosis and ultimately lead to efficient and rapid treatment of a sick patient. But the student must also understand that capnography is just one assessment tool to assist in making a diagnosis. There are other non-invasive tools available to assist in making a diagnosis prior to moving forward with appropriate treatment. Those tools can be as simple as the interpretation of basic vital signs such as blood pressure, pulse, respiratory rate, temperature, and pulse oximetry or as complex as blood chemistry, blood counts, x-ray, and CT scans. This book will not go into detail on these diagnostic tools but instead focus on the data obtained through capnography and how to place that data into usable information.
Capnography, either time-based or volume-based, has been available in the clinical setting for more than 30 years, and has been evaluated in numerous conditions where CO2 production, transport and elimination were involved. Even if many scientific societies have recommended its use as a monitoring parameter in anesthesiology, intensive care or the emergency room, there are still few formal recommendations on the use of capnography as a diagnostic, prognostic or therapeutic tool. Two explanations support this statement: first, such applications for capnography deserve a full validation process; secondly, testing CO2 kinetics in other ways than by monitoring is the specific domain of Volumetric Capnography (VCap), which is still an emerging technology. These obstacles probably explain why VCap is still at the border between clinical research and clinical practice. We considered this work as necessary steps in the way of overcoming those two obstacles. Indeed, we completed a full first step evaluation of Vcap as a potential diagnostic tool in pulmonary embolism (PE), as well as a therapeutic monitoring tool during thrombolysis for this disease.
Anesthesiologists have been using capnography for decades to monitor end-tidal carbon dioxide (ETCO2) in patients receiving general anesthesia. ETCO2 monitoring using capnography devices has application across several hospital and pre-hospital settings, including monitoring the effectiveness of cardiopulmonary resuscitation (CPR), continuous monitoring of patients in the emergency room or intensive care unit (ICU), during ambulatory transport, to confirm the correct placement of an endotracheal tube (ETT), and monitoring post-operative patients with a history of sleep apnea or who have received high doses of opioids. Depending on the clinical area, the technology is at various stages of adoption. The growing utility of ETCO2-monitoring technology in diverse clinical settings, the uncertainty regarding the clinical and cost-effectiveness of capnography devices, and access and implementation issues were the main drivers for this health technology assessment (HTA).
"Waveform capnography has been successfully used as a standard of care in the operating room setting for decades. Sedation related respiratory depression is a patient safety risk costing the health care system millions. Only recently has the technology begun to breach the sterile corridor and become a standard of care in areas outside the operating room theater. After one hospital identified an increasing patient safety concern for emergency department patients receiving intravenous sedation and analgesia, a literature review was conducted to identify technological advances to increase clinician recognition for respiratory depression. After an intensive literature review significant, congruent evidence supported a pilot policy change to utilize waveform capnography in conjunction with pulse oximetry to monitor both oxygenation and ventilation of the at-risk patient population. Utilizing the Problem-Evaluation- (PET) portion of John Hopkins Nursing Evidence Based Practice Model, a project plan was formulated incorporating best practices elicited from the literature review. Volunteer participants were recruited to participate in an educational offering on the use, interpretation, and application of waveform capnography. In conjunction with the anesthesiology department, the intensive education program was developed. Pre and post test scores were assessed in areas of written and scenario based applications. Competency demonstration was required before participants could utilize the technology on patients. After education was provided and competency assessed, participants incorporated waveform capnography use on patients 18-65 years of age receiving intravenous sedation and analgesia in the emergency department. Educational effectiveness was determined using a pre and post test model with a paired t-test analysis for statistical significance. Evaluation of adherence to use, respiratory depression occurrence rates, and adverse respiratory events were conducted. Pre-implementation rates were compared to post implementation rates to determine if waveform capnography affected patient care and improved patient safety with an intended outcome of a 93% reduction in occurrences. An eight week evaluation period was used to determine if the intervention was effective in improving recognition of respiratory depression and allowing intervention time to reduce incidence of medication reversals and advanced airway interventions. Outcomes for the project were deemed successful in both the education and utilization phases. Every participant had a score of 90% or higher on the educational post-test. Application of the knowledge was evident with the reduction in adverse respiratory events and medication reversals related sedative and narcotic medications in the emergency department resulting in a zero occurrence rate. In an effort to share the patient safety gains with other similar organizations, next steps for the project administrator and facility include a more longitudinal evaluation and dissemination of outcomes and implications from the project implementation. Translating the change to a larger platform locally and nationally with educational offerings, manuscripts, and conferences will be a top priority. With the success of this project future evidence-based practice change projects will follow a similar format." -- Abstract.
Capnography is a noninvasive technique rapidly gaining acceptance as a routine monitor of ventilation that can detect dangerous problems in gas exchange. The authors explains the basics, the technology, and the subtleties of interpretation. Annotation copyrighted by Book News, Inc., Portland, OR
Manual of Emergency Airway Management, now in its 4th edition, is a practical guide to emergency airway management in any adult or pediatric patient and offers step-by-step instructions on techniques, drug administration, and prevention and management of complications.The book may be used in conjunction with the Difficult Airway CourseTM, or on its own. The text has been reorganized to reflect the decision-making process of emergency care providers treating the patient in distress. Features include: Completely reorganized chapters into cohesive sections Expanded discussion of videolaryngoscopes, including newer, low-cost alternatives More illustrations, with expanded "how to" descriptions Revised and updated airway algorithms