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How to Read and Interpret End-Tidal Capnography Waveforms

Capnography is a great way to confirm airway device placement and monitor ventilation, but it can do so much more. Carbon dioxide (CO2) is a product of metabolism transported via perfusion and expelled through ventilation. End-tidal carbon dioxide (EtCO2) waveform monitoring allows you to measure all three simultaneously, making it the most important vital sign you use.1 To evaluate the metabolism, ventilation and perfusion of a patient through EtCO2 waveform monitoring you need to read the PQRST: proper, quantity, rate, shape and trend. Proper means that you should know the normal readings for quantity, rate, shape and trending of EtCO2. In this case, normal means what we find in a healthy person with no metabolism, ventilation or perfusion problems. One of the great things about EtCO2 is that although ventilation rates vary based on age, normal readings for quantity, shape and trends are the same for men and women of all age groups, making them easy to remember. Quantity; target EtCO2 value should be 35-45 mmHg. Rate of ventilation should be 12-20 breaths per minute (bpm) for adults if the patient is breathing on their own and 10-12 bpm if you're ventilating them. Children should be ventilated at a rate of 15-30 bpm; 25-50 bpm for infants. Ventilating too quickly won't let enough CO2 build up in the alveoli, resulting in lower EtCO2 readings. Ventilating too slowly will allow extra CO2 to build up, resulting in higher readings. Shape of the waveform should normally be a rec...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Patient Care Source Type: news

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Source: Cardiophile MD - Category: Cardiology Authors: Tags: Coronary Interventions Source Type: blogs
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Source: European Journal of Nuclear Medicine and Molecular Imaging - Category: Nuclear Medicine Source Type: research
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Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusions Although elderly patients have a more prolonged recovery after elective aortic hemiarch reconstruction for aneurysmal disease, outcomes are acceptable with low operative mortality and with the majority being discharged home. Moderate hypothermic circulatory arrest with antegrade cerebral perfusion is a safe strategy for this cohort. Advanced age alone should not be viewed as a contraindication in these cases.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Conclusions The incidence of VCD and swallowing dysfunction in neonates undergoing aortic arch reconstruction is high. Patients with VCD have a significantly higher incidence of gastrostomy placement and aspiration. In the Norwood population, length of stay is not associated with presence or absence of VCD. More than 70% of patients in each group who had direct flexible laryngoscopy follow-up recovered vocal cord function.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Conclusions Future studies examining lung transplantation outcomes with EVLP must consider the excellent results that can be achieved by using marginal lungs and conventional donor management. It is important to consider that adopting a strategy of perioperative lung donor evaluation and intervention allows use of what are considered marginal lungs to achieve promising results.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
AbstractPurpose of ReviewStress echocardiography (SE) is a well-established technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). This review article summarizes the status of SE in CAD, including testing protocols, clinical efficacy and current use of newer technologies: myocardial perfusion, strain imaging, three-dimensional echocardiography and adjunctive carotid ultrasonography.Recent FindingsRecent major findings in SE include the clinical value of myocardial perfusion imaging in multicentre studies, as well as when added to left ventricular (LV) wall mot...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
ABSTRACT: Hydrogen sulfide (H2S) is a novel signaling molecule most recently found to be of fundamental importance in cellular function as a regulator of apoptosis, inflammation, and perfusion. Mechanisms of endogenous H2S signaling are poorly understood; however, signal transmission is thought to occur via persulfidation at reactive cysteine residues on proteins. Although much has been discovered about how H2S is synthesized in the body, less is known about how it is metabolized. Recent studies have discovered a multitude of different targets for H2S therapy, including those related to protein modification, intracellular ...
Source: Shock - Category: Emergency Medicine Tags: Review Articles Source Type: research
Preeclampsia is associated with hypertension, small-for-gestational-age babies and increased cytolytic natural killer (NK) cells. The specific role of cytolytic NK cells in the pathophysiology of preeclampsia has not been clearly defined. We hypothesized that Reduced Uterine Perfusion Pressure (RUPP) stimulates proliferation and cytolytic activation of NK cells, and that reducing NK cells in RUPP would prevent hypertension, intrauterine growth restriction, and inflammation in response to placental ischemia. RUPP was induced on gestation day (GD) 14 in pregnant rats. NK cells were depleted by i.p. administration of anti-asi...
Source: Clinical Science - Category: Biomedical Science Authors: Tags: PublishAheadOfPrint Source Type: research
V Udayabhaskaran, ET Arun Thomas, Bhagya ShajiIndian Journal of Critical Care Medicine 2017 21(10):698-702Capillary leak syndrome is a unique complication that follows Russell's viper envenomation. This syndrome has a very high fatality rate and is characterized by parotid swelling, chemosis, periorbital edema, hypotension, albuminuria, hypoalbuminemia, and hemoconcentration. This syndrome is frequently recognized from the southern parts of India, especially from the state of Kerala. It has been postulated that a vascular apoptosis inducing component of Russell's viper venom that is not neutralized by the commercia...
Source: Indian Journal of Critical Care Medicine - Category: Intensive Care Authors: Source Type: research
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