Delivering Effective Ventilations Part 2

Course overview

Objectives Describe sidestream waveform capnography and its use in monitoring the delivery of effective ventilations Describe oscillations in capnography and their value in monitoring effective ventilations specifically during cardiac arrest management Content In this follow up episode Bruce and the team continue their discussion on ventilation and airway management This episode goes into much greater depth on how ETCO2 can be used to manage an array of patients effectively and how a thorough understanding and monitoring of end tidal during a resuscitation attempt can help ensure a patient remains neurologically intact assuming ROSC is achieved Bruce covers case studies on this topic and the team has the opportunity to look at the oscillations in end tidal and how they provide vital information on the efficacy of CPR and PPVs This episode provides unique insight and information on the delivery of effective ventilations and how to best use the tools in our toolbox to ensure our patients receive the highest possible level of care This episode highlights the central theme of part 1 that airway management should not be lightly handed over to the least experienced provider instead thorough training should be provided to all members of a crew to ensure all are competent and understand the weight and importance of the delivery of effective ventilations to not only the management of the patient while they are in crisis but to their longevity following the incident Below are graphics and their descriptions provided by Bruce to help understand concepts discussed in the course This example shows Oscillations 30 2 Ventilations This patient is intubated Patent Airway Tidal Volume is excellent and compressions look high quality You can see it all play out Also notice that in the 30 2 the first end tidal waveform is shortened That is because we are trying to give 2 really fast breaths so we interrupt the first breath out with an immediate second breath in giving it a shortened waveform This is trained at TVFR to give your two breaths and then look for a shortened waveform and the second breath has the compressions Appreciate how consistently our variables are working together and the end tidal is not wavering or all over the place Bruce Opsal The above example is a crew that gave the bonus breaths that I discussed in the podcast Rhythm change sinus bradycardia not perfusing and the end tidal drastically is dropping breath by breath You might think if I give 4 stacked breaths would that lower the end tidal and the answer is no You will not have a drastic change as that where the first breath is around 50 and by their fifth breath it is at 20 I would argue that it will just outright sustain if the heart is perfusing A student contested this so I just had him put on an end tidal and a monitor and watched him try to drop his capnometry even one point from 1 to 5 breaths and he could not do it Bruce Opsal