Morning Report: 6/20/2013

Today’s Morning Report is courtesy of Dr. DiMare!

Color Change Capnography

How does it work?

• pH based
• REVERSIBLY reacts with expired CO2
• purple with ETCO2 < 3mmHg
• yellow with ETCO2> 15mmHg

How good is it?

–       nearly 100% specific (97-100% different studies, different devices)

• WHEN USED PROPERLY

–       sensitivity varies greatly with patient condition (20-100%)

False Positives & Solutions

–       copious bagging has forced CO2 into esophagus/stomach

• observe color change back and forth 6 times

–       ETT is in hypopharynx

• Capnography should only be used IN CONJUNCTION WITH visualization

–       Gastric contents, mucous, medication such as epinephrine and lidocaine

• Will cause a permanent change, must observe back and forth color change

False Negatives

–       Cardiac arrest

• Patient is not generating enough CO2 to cause color change

–       Massive PE

• Gas exchange is limited

–       Large dose IV epi, such as during cardiac arrest

• Theoretically can decrease ETCO2
  • Unclear when/if it will decrease it enough to prevent color change

References:

Srinivasa V, Kodali BS. Caution when using colorimetry to confirm endotracheal intubation. Anesth Analg 2007;104:738

Nagler, Joshua, and Baruch Krauss. “Capnography: a valuable tool for airway management.” Emergency medicine clinics of North America 26.4 (2008): 881-897.

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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