Aleadelectrocardiogram.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Capnography Is the measurement of exhaled carbon dioxide gas and can be used to monitor a patients ventilatory status. A capnograph is also known as an end-tidal CO2 monitor, because the CO2 is measured near the end of the exhalation. Most often, the gas sample is analyzed through infrared gas analysis. Frequently the CO2 is measured via the exhalation port of the ventilator tubing; as the gas passes through the sensor, the data are transferred to the display unit. A display unit produces a waveform, called a capnogram and a numeric recording approximating the Paco2. The ability of the capnograph to approximate arterial Paco2 is altered with abnormal cardiopulmonary function Clinical application ofcapnography can provide information in a number of areas including: Estimation of Paco2 levels, Assessment of dead space (increased V/Q), Assessment of pulmonary blood flow, and endotracheal tube placement. Normally alveolar and arterial CO2 concentrations are equal in the presence of normal ventilation/perfusion relationships. In a patient who is hemodynamically stable, the end-tidal CO2 (Petco2) can be used to estimate the Paco2, with the Petco2 levels 1 to 5 mm Hg less than Paco2 levels.The practitioner must determine first that a normal V/Q relationship exists before correlation of the Petco2 and the Paco2 can be assumed. Assessment of changes in physiologic dead space can be carried out with end-tidal CO2 monitoring, based on the degree of difference between the Paco2 and the Petco2. As the severity of pulmonary impairment increases, so does the disparity between the Paco2 and the Petco2, as indicated by an increased gradient. A gradient of greater than 5 mm Hg can be seen with underperfused alveolar-capillary units (dead space–producing situations) and nonperfused alveolar-capillary units (alveolar dea