Nonin RespSense Sidestream End Tidal CO2 Monitor

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Nonin Resp?SenseSidestream End Tidal CO2 Monitor
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Nonin RESP?SENSE
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Nonin RESP?SENSE

• Associated Parts
• -Nasal Cannula Sampling Tubing
• - ETT Sampling Tubing
• - ETT Adapter
• - Moisture Barrier
• - Moisture Trap
• - Power Charger
• - Carrying Case

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Nonin RESP?SENSE

• Widescreen touch panel display
• Numerical ETCO2 and respiratory rate display
• MedAir ETCO2 technology
• 1.5 hours of ETCO2 and respiration rate waveform
  trending
• Backlit LCD display
• Audible and visual alarms
• Data output via RS-232 port
• Weight 2 lbs.

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Nonin RESP?SENSE

• Nasal Cannula
• ETT Connector
• Standard 15/22mm
• Single use Moisture Trap and Filter

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Nonin RESP?SENSE

• Resp?Sense Audible and Visual Alarm Features
• Capnography NO CAPNO
• No communication from capnography unit.
• Capnography WARM UP
• Warm-up delay and stabilizing measurements.
• System BATT LOW
• Battery is almost depleted.
• System DISP ERROR
• The touch panel display is not working properly.

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Nonin RESP?SENSE

• Resp?Sense Audible and Visual Alarm Features
• Capnography OCCLUSION
• Low or no flow from sample line tubing.
• Capnography TRAP FULL/PUSH ALARM
• There has been an occlusion for several seconds,
  possibly due to moisture in the moisture trap.
  Replace it and then press the audible alarm
  pause button.

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Nonin RESP?SENSE

• Battery data
• Type LiION internal battery hard wired to the
  circuit board, Nonin must replace.
• Battery capacity
• 6 10 hours expected on a full charge
• Expected life cycle
• 5 years
• Charging time
• 24 hours from empty to full
• Or 2 hours for every hour to run on battery

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Nonin RESP?SENSE

• Turn units power on
• Select audible alarm then Pediatric or Adult
  (weight based)
• Insert circuit into the Nonin unit and attach
  the 15/22mm adapter in between the BVM and the
  Endotracheal Tube or rescue airway device
• Begin ventilations and patient monitoring
• (do not adjust alarm parameters)
• Fluid trap and filter get changed (as needed)

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Nonin RESP?SENSE

• INTUBATED PATIENT APPLICATIONS
• Verification of ETT placement
• ETT surveillance during transport
• CPR compression efficacy, early sign of ROSC,
  Cardiac Arrest survival predictor
• Average range of ETCO2 35 45 mm Hg

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Nonin RESP?SENSE

• Three Questions to ask EVERY TIME CAPNOGRAPHY IS
  USED
• 1. IS THE ET TUBE IN THE TRACHEA (rise and fall
  of detectable CO2)?
• 2. WHAT IS THE ETCO2 VALUE (height of the
  waveform)?
• 3. WHAT IS THE SHAPE OF THE WAVEFORM?

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Nonin RESP?SENSE understanding capnography
waveforms
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Nonin RESP?SENSE
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Nonin RESP?SENSE

• Circulation and Metabolism
• While capnography is a direct measurement of
  ventilation in the lungs, it also indirectly
  measures metabolism and circulation.
• Example, an increased metabolism will increase
  the production of carbon dioxide increasing the
  ETCO2.
• A decrease in cardiac output will lower the
  delivery of carbon dioxide to the lungs
  decreasing the ETCO2 (smaller waveform).
• Capnography versus Pulse Oximetry
• Capnography is immediate, pulse oximetry is
  delayed. Hold your breath. Capnography will show
  immediate apnea, while pulse oximetry will show a
  high saturation for several minutes.

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Nonin RESP?SENSE

• The normal wave form appears as straight boxes on
  the monitor screen
• The waveform begins before exhalation and ends
  with inspiration. Breathing out comes before
  breathing in.

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Nonin RESP?SENSE

• A to B is post inspiration/dead space exhalation,
  
• B is the start of alveolar exhalation,
• B-C is the exhalation upstroke where dead space
  gas mixes with lung gas,
• C-D is the continuation of exhalation, or the
  plateau (all the gas is alveolar now, rich in
  ETCO2).
• D is the end-tidal value the peak
  concentration,
• D-E is the inspiration washout

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Nonin RESP?SENSE

• NORMAL Square box waveform
• baseline CO2 0 ETCO2 35-45 mm Hg
• Management Monitor patient

• DISLODGED ETT Loss of waveform, Loss of ETCO2
  reading
• Management Replace ET

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Nonin RESP?SENSE

• ESOPHAGEAL INTUBATION Absence of waveform,
  Absence of detectable ETCO2.
• Management Re-intubate

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Nonin RESP?SENSE

• CPR Square box waveform
• baseline CO2 0 ETCO2 10-15 mm Hg (possibly
  higher) with adequate CPR
• Management Change rescuers if ETCO2 drops lt 10

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Nonin RESP?SENSE

• If EtC02 is less than 35 mmHg,
• the patient is hypoperfusing through the lungs,
• hyperventilating,
• hypometabolic (hypothermia)
• or minimal C02 to sensor
• Causes gt cardiac arrest, shock, blood loss,
  embolism can impair blood carrying C02 from
  getting to the lungs.
• -hyperventilation can cause C02 to be exhaled
  faster than it is produced by body cells.
• -hypothermia decreases C02 metabolism
• -DKA associated with hyperventilation
• -ETT tube kink or obstruction ie. secretions

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Nonin RESP?SENSE

• SHARKFIN w prolonged expiration Bronchospasm
  (Asthma, COPD, allergic reaction)
• Management Bronchodilators (Albuterol,
  Ipratropium Bromide, or epinephrine)

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Nonin RESP?SENSE

• Return Of Spontaneous Circulation ROSC
• As in CPR, ETCO2 rises above 10-15 mm Hg
• Management Check for pulse contact OLMC for
  post arrest options

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Nonin RESP?SENSE

• RISING BASELINE Patient is rebreathing CO2
  Management Check equipment for adequate oxygen
  inflow
• Management Allow the intubated patient more time
  to exhale

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Nonin RESP?SENSE

• HYPOVENTILATION number of RR Prolonged
  waveform baseline CO2 0 ETCO2 gt 45 mm Hg
• Management Assist ventilations or intubate, if
  needed

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Nonin RESP?SENSE

• HYPERVENTILATION Increased RR shortened
  waveform baseline ETCO2 0 ETCO2 lt 35 mm Hg
• Management Biofeedback if conscious, decrease
  assisted ventilation rate if unconscious/intubated
  

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Nonin RESP?SENSE

• CO2 above 45 mmHg can be caused by
  hypoventilation
• Because the respiratory rate and or depth is not
  sufficient to exhale steadily produced C02, it is
  retained and each exhaled breath contains a high
  amt of C02 (however small the number or volume of
  breaths maybe)
• Other causes Chronic COPD damage may cause
  chronic hypercapnia, Hyperthermia

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Nonin RESP?SENSE

• PATIENT BREATHING AROUND ET TUBE angled, sloping
  downstroke waveform
• Adult Broken cuff or tube is too small
• Pediatric tube is too small
• Management Assess patient, oxygenation,
  ventilation may need to reintubate

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Nonin RESP?SENSE

• Capnography is only a tool to assist clinical
  judgment as serial tracings are monitored and
  treatments are provided.
• CO2 produced in tissues from glucose metabolism,
  goes via blood stream to aveolar-pulmonary-capilla
  ry bed where it is exhaled via cellular
  respiration.
• averageEtCO2 is 35-45 mmHg.
• Major use is in newly intubated patients,
• No waveform, No Digital number, likely ETT is
  misplaced