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13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
13 icu monitoring standards and capnography
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13 icu monitoring standards and capnography

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  • Hello, I discovered your very interesting presentations in the Slideshare group 'HEALT AND MEDICINE' (http://www.slideshare.net/group/healt-and-medicine ). I take this opportunity to referencer some of your presentations. Thank for sharing. Greetings from France. Good day. Kate
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  • 1. Dr Ajmal Eusuf ICU Monitoring Standards and Capnography
  • 2. Current Monitoring <ul><li>Personnel </li></ul><ul><li>Patient monitoring </li></ul><ul><li>Equipment monitoring </li></ul>
  • 3. Current Monitoring-patient <ul><li>Saturations and gases </li></ul><ul><li>ECG </li></ul><ul><li>Blood pressure </li></ul><ul><li>Respirations </li></ul><ul><li>Heart and lungs should have clinical monitoring intermittently </li></ul>
  • 4. Current monitoring-equipment <ul><li>Ventilator failures and supply </li></ul><ul><li>Oxygen analysis </li></ul><ul><li>Disconnection alarms </li></ul><ul><li>Volume and pressure alarms </li></ul><ul><li>Temperature </li></ul>
  • 5. Rational for capnography <ul><li>Would you put a patient to sleep in theatre without capnography being present? </li></ul><ul><li>Would you keep them asleep without capnography? </li></ul><ul><li>Must of our theatre patients are fit and well </li></ul><ul><li>ICU patients are sicker </li></ul><ul><li>One set of equipment for all the unit which takes a few minutes to set up </li></ul>
  • 6. Capnographic analysis <ul><li>Primarily used for correct intubation </li></ul><ul><li>Can also be used for 1)tidal volume </li></ul><ul><li>2) dead space </li></ul><ul><li>3) partial obstruction </li></ul><ul><li>4) breath stacking </li></ul><ul><li>5) analysis of chronic airway disease </li></ul><ul><li>Examples: </li></ul>
  • 7. <ul><li>Normal </li></ul>
  • 8. <ul><li>Capnograph breating around tube </li></ul>
  • 9. <ul><li>CPR capnograph </li></ul>
  • 10. <ul><li>Disconnection </li></ul>
  • 11. <ul><li>Oesophageal intubation </li></ul>
  • 12. <ul><li>Hyperventilation </li></ul>
  • 13. <ul><li>Hypoventilation </li></ul>
  • 14. <ul><li>Rising baseline </li></ul>
  • 15. <ul><li>ROSC </li></ul>
  • 16. <ul><li>Sharkfin </li></ul>
  • 17. <ul><li>Phase 1- anatomical and apparatus dead space </li></ul><ul><li>Phase 2- mixing of dead space and alveolar CO2 </li></ul><ul><li>Phase 3- alveolar plateau </li></ul><ul><li>Phase 4- start of inspiration </li></ul>
  • 18. &nbsp;
  • 19. &nbsp;
  • 20. Critical incidents <ul><li>In theatre! Australian study showed endobronchial intubation was most common incident at 42% </li></ul><ul><li>Oesophageal intubation was 18% </li></ul><ul><li>58% of these incidents were picked up via CO2 and SpO2, 25% picked up clinically </li></ul><ul><li>Was calculated that 93% of all incidents should be picked up via CO2, SpO2 and BP. </li></ul>
  • 21. Comparisons <ul><li>Anaesthetic and recovery guidelines are roughly the same </li></ul><ul><li>American ICS specifies capnography as mandatory monitoring </li></ul><ul><li>UK ICS still debating this </li></ul><ul><li>Most units now have capnography as mandatory for intubation purposes, but only 50% use this! </li></ul><ul><li>Comparisons of theatre and ICU patients </li></ul>
  • 22. Conclusion <ul><li>Capnography has a wide range of uses </li></ul><ul><li>For better compliance of UK unit protocols, probably need it as bedside monitoring </li></ul><ul><li>Lagging behind other world-wide practises </li></ul><ul><li>Probably needed more by ICU than theatres? </li></ul>
  • 23. Any Questions?

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