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capnography-monitoring-waveforms-interactive - 1

Normal Abnormal Apnea Hypoventilation CAPNOGRAPHY WAVEFORMS 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation Hyperventilation 9 Tachypnea with hypocarbia Rebreathing of CO2 Partial airway obstruction Lower airway obstruction / COPD Cardiac arrest with manual CPR Return of spontaneous circulation (ROSC) Curare cleft ©2017 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic™. All other brands are trademarks of a Medtronic company. 17-PM-0115

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INTERVENTION1 None required, continue sedation RR Normal Waveform Normal Apnea Hypoventilation ■-►Bradypneic hypoventilation ■-►Hypopneic hypoventilation Hyperventilation ■-►Tachypnea with hypocarbia Rebreathing of CO2 Respiratory rate is generally between 12-20 breaths per minute for adults. ■ Breathing pattern occurs approximately once every 3-5 seconds ■ Inspired air contains little to no carbon dioxide and expired air contains about 4-6% CO2 ■ Baseline normally at zero The normal respiratory rates referenced in this document are for adults. Young children (< 12 years old) will have...

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Normal Abnormal Apnea Hypoventilation Four Phases: ▪▪Phase I: exhaled gas from conducting airways ▪▪Phase II: a mixture of gas from the conducting airways and alveoli ▪▪Phase III: the alveolar plateau ▪▪Phase 0: inspired air NORMAL WAVEFORM PHASES Overview The waveform should return to baseline, the frequency should match the patient’s respiratory rate and the height of the waveform should be between 35-45 mmHg, which is the normal etCO2 reading4 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation ▪▪Gas is exhaled from the large 9 Tachypnea with hypocarbia ▪▪Begins with air leaving the...

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capnography-monitoring-waveforms-interactive - 4

Normal Abnormal Apnea Hypoventilation Four Phases: ▪▪Phase I: exhaled gas from conducting airways ▪▪Phase II: a mixture of gas from the conducting airways and alveoli ▪▪Phase III: the alveolar plateau ▪▪Phase 0: inspired air NORMAL WAVEFORM PHASES Overview The waveform should return to baseline, the frequency should match the patient’s respiratory rate and the height of the waveform should be between 35-45 mmHg, which is the normal etCO2 reading4 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation Hyperventilation 9 Tachypnea with hypocarbia Rebreathing of CO2 PHASE II: ▪▪The ascending...

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Normal Abnormal Apnea Hypoventilation Four Phases: ▪▪Phase I: exhaled gas from conducting airways ▪▪Phase II: a mixture of gas from the conducting airways and alveoli ▪▪Phase III: the alveolar plateau ▪▪Phase 0: inspired air NORMAL WAVEFORM PHASES Overview The waveform should return to baseline, the frequency should match the patient’s respiratory rate and the height of the waveform should be between 35-45 mmHg, which is the normal etCO2 reading4 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation Hyperventilation 9 Tachypnea with hypocarbia PHASE III: ▪▪The carbon dioxide...

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capnography-monitoring-waveforms-interactive - 6

Normal Abnormal Apnea Hypoventilation Four Phases: ▪▪Phase I: exhaled gas from conducting airways ▪▪Phase II: a mixture of gas from the conducting airways and alveoli ▪▪Phase III: the alveolar plateau ▪▪Phase 0: inspired air NORMAL WAVEFORM PHASES Overview The waveform should return to baseline, the frequency should match the patient’s respiratory rate and the height of the waveform should be between 35-45 mmHg, which is the normal etCO2 reading4 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation Hyperventilation 9 Tachypnea with hypocarbia END OF PHASE III: ▪▪The end of exhalation...

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Normal Abnormal Apnea Hypoventilation Four Phases: ▪▪Phase I: exhaled gas from conducting airways ▪▪Phase II: a mixture of gas from the conducting airways and alveoli ▪▪Phase III: the alveolar plateau ▪▪Phase 0: inspired air NORMAL WAVEFORM PHASES Overview The waveform should return to baseline, the frequency should match the patient’s respiratory rate and the height of the waveform should be between 35-45 mmHg, which is the normal etCO2 reading4 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation Hyperventilation PHASE 0: ▪▪Inhalation will begin ▪▪Oxygen fills the airway and CO2...

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▪▪Capnography provides a continuous, real-time indication of adequacy of ventilation ▪▪Capnography provides the earliest ABNORMAL WAVEFORMS indication of evolving respiratory compromise Apnea Hypoventilation 9 Bradypneic hypoventilation ▪▪Any deviations in the carbon dioxide waveform must be investigated ▪▪Five characteristics of a capnogram should be evaluated: ▪▪Frequency ▪▪Rhythm ▪▪Height ▪▪Baseline ▪▪Shape 9 Hypopneic hypoventilation Hyperventilation 9 Tachypnea with hypocarbia ADDRESSING ABNORMAL WAVEFORMS: If abnormal waveforms are indicated: Partial airway obstruction Lower airway...

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▪▪No breath for 10 seconds or longer ▪▪Central in nature with no respiratory effort, or obstructive, respiratory effort without air movement ▪▪Capnography alone does not provide apnea differentiation Hypoventilation 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation 9 Tachypnea with hypocarbia Rebreathing of CO2 Partial airway obstruction Lower airway obstruction / COPD Cardiac arrest with manual CPR CAUSES OF APNEA: ▪▪Cardiac arrest ▪▪Respiratory depression (e.g., opioids, sedatives, etc.) ▪▪Equipment failure ▪▪Displaced airway adjunct ▪▪Sleep apnea Return of spontaneous circulation...

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HYPOVENTILATION Abnormal Apnea Hypoventilation ‘-►Bradypneic hypoventilation ■-►Hypopneic hypoventilation Hyperventilation ■-►Tachypnea with hypocarbia Rebreathing of CO2 Partial airway obstruction Lower airway obstruction / COPD Cardiac arrest with manual CPR Return of spontaneous circulation (ROSC) Curare cleft ■ Build-up of carbon dioxide as a result of insufficient elimination of the byproduct ■ May result during normal respiratory rate, slow respiratory rate (bradypnea), or insufficient tidal volume (hypopnea) ■ Shape or "morphology" of the capnogram is normal with rapid increase in...

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capnography-monitoring-waveforms-interactive - 11

WHAT IT IS: ▪▪Form of hypoventilation BRADYPNEIC HYPOVENTILATION abnormally high level of carbon dioxide in the circulating blood Apnea Hypoventilation ▪▪Respiratory rate may vary but generally slow and below a rate of 12 breaths per minute, representing bradypnea ▪▪Enlarged waveform with a rapid 9 Bradypneic hypoventilation 9 Hypopneic hypoventilation Hyperventilation increase in phase II, gradual and smooth upslope during phase III, abrupt descent during phase 0 back to inhalation ▪▪End-tidal carbon dioxide levels generally above normal ▪▪Breathing pattern usually regular, occurs less...

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