Da fährt einfach n NEF regelhaft mit rum 😭
Kein SpO2, kein NIBP, kein etCO2
Blutdruck manuell, keine etCO2 Messung vorhanden 💀
Kein SpO2, kein NIBP, kein etCO2
Blutdruck manuell, keine etCO2 Messung vorhanden 💀
April 16, 2025 at 10:40 AM
Da fährt einfach n NEF regelhaft mit rum 😭
Kein SpO2, kein NIBP, kein etCO2
Blutdruck manuell, keine etCO2 Messung vorhanden 💀
Kein SpO2, kein NIBP, kein etCO2
Blutdruck manuell, keine etCO2 Messung vorhanden 💀
This is important because we often use ETCO2 as a resuscitation endpoint.
Unfortunately, because we *expect* a big rise in ETCO2 after pushing bicarb, ETCO2 becomes less reliable as a marker of CO for a few minutes.
More about ETCO2 here from @icuonepager.bsky.social
8/
Unfortunately, because we *expect* a big rise in ETCO2 after pushing bicarb, ETCO2 becomes less reliable as a marker of CO for a few minutes.
More about ETCO2 here from @icuonepager.bsky.social
8/
November 19, 2024 at 2:07 PM
This is important because we often use ETCO2 as a resuscitation endpoint.
Unfortunately, because we *expect* a big rise in ETCO2 after pushing bicarb, ETCO2 becomes less reliable as a marker of CO for a few minutes.
More about ETCO2 here from @icuonepager.bsky.social
8/
Unfortunately, because we *expect* a big rise in ETCO2 after pushing bicarb, ETCO2 becomes less reliable as a marker of CO for a few minutes.
More about ETCO2 here from @icuonepager.bsky.social
8/
LP15 ja meinetwegen noch, aber auch die gibt es mit EKG, SpO2, NIBP und etCO2... :D
April 16, 2025 at 10:42 AM
LP15 ja meinetwegen noch, aber auch die gibt es mit EKG, SpO2, NIBP und etCO2... :D
Du willst mir sagen, dass NEF hat gar keine etCO2-Messung?!
April 16, 2025 at 10:42 AM
Du willst mir sagen, dass NEF hat gar keine etCO2-Messung?!
Naja: initial PEA, RV weit, etCO2 immer miserabel, und Riikofaktoren... da würde ich mit gehen. Alles andere oder jedes davon für sich allein - eher nicht.
April 13, 2026 at 4:05 PM
Naja: initial PEA, RV weit, etCO2 immer miserabel, und Riikofaktoren... da würde ich mit gehen. Alles andere oder jedes davon für sich allein - eher nicht.
#RTWlive #Dienstflosse
Ich bringe ein geriatrisches Trauma, einen Sturz mit Handgelenkfraktur, Immobilisation der Extremität sowie Z.n. repetitiver Analgesie mit Fentanyl i.v. unter Monitorbedingungen (EKG, SpO2, NIBP, etCO2) in die Notfallambulanz.
Ich bringe ein geriatrisches Trauma, einen Sturz mit Handgelenkfraktur, Immobilisation der Extremität sowie Z.n. repetitiver Analgesie mit Fentanyl i.v. unter Monitorbedingungen (EKG, SpO2, NIBP, etCO2) in die Notfallambulanz.
#NEFlive #Dienstflosse
Junger Mann kommt selbständig in die Notfallambulanz eines Grundversorgers, EKG und Tropdynamik sagen: STEMI / HWI.
Der Patient soll von uns in das benachbarte HKL gebracht werden.
Bei Eintreffen liegt der Patient unbetreut und ohne Monitorankabelung im kleinsten Raum.
Junger Mann kommt selbständig in die Notfallambulanz eines Grundversorgers, EKG und Tropdynamik sagen: STEMI / HWI.
Der Patient soll von uns in das benachbarte HKL gebracht werden.
Bei Eintreffen liegt der Patient unbetreut und ohne Monitorankabelung im kleinsten Raum.
July 15, 2026 at 7:14 PM
#RTWlive #Dienstflosse
Ich bringe ein geriatrisches Trauma, einen Sturz mit Handgelenkfraktur, Immobilisation der Extremität sowie Z.n. repetitiver Analgesie mit Fentanyl i.v. unter Monitorbedingungen (EKG, SpO2, NIBP, etCO2) in die Notfallambulanz.
Ich bringe ein geriatrisches Trauma, einen Sturz mit Handgelenkfraktur, Immobilisation der Extremität sowie Z.n. repetitiver Analgesie mit Fentanyl i.v. unter Monitorbedingungen (EKG, SpO2, NIBP, etCO2) in die Notfallambulanz.
1/3 🧵👇
Great paper.
Summary of Recommendations
(paraphrased - hope I got it right):
1. Waveform ETCO2+SpO2 whenever intubating
2. VL as routine
3. Verbalise the view at each attempt ('flying by mouth')
4. Verbalise whether sustained ETCO2 and adequate Spo2 are present
5. No Trace = Wrong Place..
Great paper.
Summary of Recommendations
(paraphrased - hope I got it right):
1. Waveform ETCO2+SpO2 whenever intubating
2. VL as routine
3. Verbalise the view at each attempt ('flying by mouth')
4. Verbalise whether sustained ETCO2 and adequate Spo2 are present
5. No Trace = Wrong Place..
The PUMA guidelines for prevention of oesophageal intubation are supported by
-RCOA
-AoA
-FICM
-ICS
-CODP
-DAS
This is true of no other airway guidance I am aware of & make them the de facto UK National guidance
associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....
associationofanaesthetists-publications.onlinelibrary.wiley.com
January 5, 2025 at 9:56 AM
1/3 🧵👇
Great paper.
Summary of Recommendations
(paraphrased - hope I got it right):
1. Waveform ETCO2+SpO2 whenever intubating
2. VL as routine
3. Verbalise the view at each attempt ('flying by mouth')
4. Verbalise whether sustained ETCO2 and adequate Spo2 are present
5. No Trace = Wrong Place..
Great paper.
Summary of Recommendations
(paraphrased - hope I got it right):
1. Waveform ETCO2+SpO2 whenever intubating
2. VL as routine
3. Verbalise the view at each attempt ('flying by mouth')
4. Verbalise whether sustained ETCO2 and adequate Spo2 are present
5. No Trace = Wrong Place..
Oh yes.
And the etCO2.
And the etCO2.
November 19, 2024 at 4:35 PM
Oh yes.
And the etCO2.
And the etCO2.
I wish we had ETCO2 😭
December 9, 2024 at 2:16 AM
I wish we had ETCO2 😭
Gold is good? 🤔
August 9, 2026 at 6:42 PM
Gold is good? 🤔
Würde sagen, seit dem TROICA trial (NEJM 2008) ist Routinelyse unter CPR ziemlich out und , wie Du sagst, für hoch wahrscheinliche LE reserviert. Dafür braucht es idR zumindest ein US Blick auf den RV.
Man mag niedrige etCO2 unter CPR für ein Indiz halten. Meist ist das aber nur schlechte HDM....
Man mag niedrige etCO2 unter CPR für ein Indiz halten. Meist ist das aber nur schlechte HDM....
April 13, 2026 at 3:46 PM
Würde sagen, seit dem TROICA trial (NEJM 2008) ist Routinelyse unter CPR ziemlich out und , wie Du sagst, für hoch wahrscheinliche LE reserviert. Dafür braucht es idR zumindest ein US Blick auf den RV.
Man mag niedrige etCO2 unter CPR für ein Indiz halten. Meist ist das aber nur schlechte HDM....
Man mag niedrige etCO2 unter CPR für ein Indiz halten. Meist ist das aber nur schlechte HDM....
one concrete thing that helps confirm principled decisions is ETCO2 <10 mmHg at 20 minutes CPR: almost no chance of ROSC
it’s often clear at this point but it does help give an “easy” answer
(keep in mind ETCO2 >10 isn’t a particularly reassuring finding per se)
it’s often clear at this point but it does help give an “easy” answer
(keep in mind ETCO2 >10 isn’t a particularly reassuring finding per se)
December 9, 2024 at 2:15 AM
one concrete thing that helps confirm principled decisions is ETCO2 <10 mmHg at 20 minutes CPR: almost no chance of ROSC
it’s often clear at this point but it does help give an “easy” answer
(keep in mind ETCO2 >10 isn’t a particularly reassuring finding per se)
it’s often clear at this point but it does help give an “easy” answer
(keep in mind ETCO2 >10 isn’t a particularly reassuring finding per se)
Kann man ja alles regeln: Anmeldediagnose 332 STEMI/OMI oder 333 NSTEMI macht i.v.-Zugang und Medikation zum Pflichtfeld. Ebenso bei der Anmeldung „Beatmung: ja“ -> etCO2 wird zum Pflichtfeld.
Schlechte/Fehlende Dokumentation muss dann allerdings auch Konsequenzen haben.
Schlechte/Fehlende Dokumentation muss dann allerdings auch Konsequenzen haben.
August 3, 2025 at 8:30 AM
Kann man ja alles regeln: Anmeldediagnose 332 STEMI/OMI oder 333 NSTEMI macht i.v.-Zugang und Medikation zum Pflichtfeld. Ebenso bei der Anmeldung „Beatmung: ja“ -> etCO2 wird zum Pflichtfeld.
Schlechte/Fehlende Dokumentation muss dann allerdings auch Konsequenzen haben.
Schlechte/Fehlende Dokumentation muss dann allerdings auch Konsequenzen haben.
Lacrosse game was cancelled, so today I clean the garage, prepare a teaching script for Monday on dead space and ETCO2, and finish reviewing CHEST abstracts.
Plus, basketball.
Plus, basketball.
March 22, 2025 at 12:36 PM
Lacrosse game was cancelled, so today I clean the garage, prepare a teaching script for Monday on dead space and ETCO2, and finish reviewing CHEST abstracts.
Plus, basketball.
Plus, basketball.
Abgesehen davon, dass ich CO2 immer nutze.
Was ändert ein etCO2 an der Abbruchentscheidung nach 35 Minuten Rea und immer Asystolie?
Was ändert ein etCO2 an der Abbruchentscheidung nach 35 Minuten Rea und immer Asystolie?
September 30, 2023 at 10:50 AM
Abgesehen davon, dass ich CO2 immer nutze.
Was ändert ein etCO2 an der Abbruchentscheidung nach 35 Minuten Rea und immer Asystolie?
Was ändert ein etCO2 an der Abbruchentscheidung nach 35 Minuten Rea und immer Asystolie?
We’ve discussed that ETCO2 nasal cannulas provide something more like blow compared to a true NC.
The max flow rate was thought to be 5-6 LPM using a ETCO2 NC.
Testing on a Hamilton T-1 in high flow mode showed I could only push ~4 LPM through the ETCO2 NC.
🚨 Consider this for PreOx and ApOx!
The max flow rate was thought to be 5-6 LPM using a ETCO2 NC.
Testing on a Hamilton T-1 in high flow mode showed I could only push ~4 LPM through the ETCO2 NC.
🚨 Consider this for PreOx and ApOx!
March 6, 2025 at 2:55 PM
We’ve discussed that ETCO2 nasal cannulas provide something more like blow compared to a true NC.
The max flow rate was thought to be 5-6 LPM using a ETCO2 NC.
Testing on a Hamilton T-1 in high flow mode showed I could only push ~4 LPM through the ETCO2 NC.
🚨 Consider this for PreOx and ApOx!
The max flow rate was thought to be 5-6 LPM using a ETCO2 NC.
Testing on a Hamilton T-1 in high flow mode showed I could only push ~4 LPM through the ETCO2 NC.
🚨 Consider this for PreOx and ApOx!
That’s enough CO2 that we can actually see the increase in end tidal CO2 after pushing an amp of bicarb.
Here’s an experiment done on anesthetized dogs: ETCO2 increased by about 25%.
onlinelibrary.wiley.com/doi/abs/10.111…
6/
Here’s an experiment done on anesthetized dogs: ETCO2 increased by about 25%.
onlinelibrary.wiley.com/doi/abs/10.111…
6/
November 19, 2024 at 1:55 PM
That’s enough CO2 that we can actually see the increase in end tidal CO2 after pushing an amp of bicarb.
Here’s an experiment done on anesthetized dogs: ETCO2 increased by about 25%.
onlinelibrary.wiley.com/doi/abs/10.111…
6/
Here’s an experiment done on anesthetized dogs: ETCO2 increased by about 25%.
onlinelibrary.wiley.com/doi/abs/10.111…
6/
You intubate a patient smoothly with roc & ketamine
After connection with the vent:
- oxygen saturation is 98%
- etCO2 tracing & values are normal
- breath sounds are symmetric
the vent starts alarming for a 60% air leak
you ascultate the neck & cannot hear a leak
what is happening? #1/2 #EMIMCC
After connection with the vent:
- oxygen saturation is 98%
- etCO2 tracing & values are normal
- breath sounds are symmetric
the vent starts alarming for a 60% air leak
you ascultate the neck & cannot hear a leak
what is happening? #1/2 #EMIMCC
a man in a tie is standing in front of a sign that says `` what is going on ? ''
ALT: a man in a tie is standing in front of a sign that says `` what is going on ? ''
media.tenor.com
May 17, 2025 at 7:50 PM
You intubate a patient smoothly with roc & ketamine
After connection with the vent:
- oxygen saturation is 98%
- etCO2 tracing & values are normal
- breath sounds are symmetric
the vent starts alarming for a 60% air leak
you ascultate the neck & cannot hear a leak
what is happening? #1/2 #EMIMCC
After connection with the vent:
- oxygen saturation is 98%
- etCO2 tracing & values are normal
- breath sounds are symmetric
the vent starts alarming for a 60% air leak
you ascultate the neck & cannot hear a leak
what is happening? #1/2 #EMIMCC
What’s his ETCO2. Asking for a friend
September 2, 2025 at 6:50 PM
What’s his ETCO2. Asking for a friend
Erstaunlich, mein Rettungsdienstbereich ist bei den Daten des Reanimationsregisters in allem besser als die Gesamtdaten: tCPR, Bystander-CPR, SpO2, RR, etCO2 im Zielbereich, CPC1+2 bei Entlassung über 90%. Nur die „Lebend entlassen“-Rate ist deutlich schlechter als im Gesamtvergleich.
August 9, 2025 at 9:38 AM
Erstaunlich, mein Rettungsdienstbereich ist bei den Daten des Reanimationsregisters in allem besser als die Gesamtdaten: tCPR, Bystander-CPR, SpO2, RR, etCO2 im Zielbereich, CPC1+2 bei Entlassung über 90%. Nur die „Lebend entlassen“-Rate ist deutlich schlechter als im Gesamtvergleich.
One important thing to remember:
ETCO2 & pH is going to increase after a push of bicarb, but…
In someone who is already maxed on the ventilator (e.g. a ARDS with acidosis), it may take a long time to clear this extra CO2.
If you can’t clear the extra CO2 the pH won’t rise. So no benefit.
10/
ETCO2 & pH is going to increase after a push of bicarb, but…
In someone who is already maxed on the ventilator (e.g. a ARDS with acidosis), it may take a long time to clear this extra CO2.
If you can’t clear the extra CO2 the pH won’t rise. So no benefit.
10/
November 19, 2024 at 2:20 PM
One important thing to remember:
ETCO2 & pH is going to increase after a push of bicarb, but…
In someone who is already maxed on the ventilator (e.g. a ARDS with acidosis), it may take a long time to clear this extra CO2.
If you can’t clear the extra CO2 the pH won’t rise. So no benefit.
10/
ETCO2 & pH is going to increase after a push of bicarb, but…
In someone who is already maxed on the ventilator (e.g. a ARDS with acidosis), it may take a long time to clear this extra CO2.
If you can’t clear the extra CO2 the pH won’t rise. So no benefit.
10/
3/3
9. Remove ETT if
- OI cannot be excluded
- No sustained ETCO2
- SpO2 falls before restoring ETCO2
10. Standardise and improve salience of monitor displays.
11. interprofessional team training to implement these guidelines
(they don't use the term sociotechnical but it's sociotechnical)
🙏
9. Remove ETT if
- OI cannot be excluded
- No sustained ETCO2
- SpO2 falls before restoring ETCO2
10. Standardise and improve salience of monitor displays.
11. interprofessional team training to implement these guidelines
(they don't use the term sociotechnical but it's sociotechnical)
🙏
January 5, 2025 at 9:56 AM
3/3
9. Remove ETT if
- OI cannot be excluded
- No sustained ETCO2
- SpO2 falls before restoring ETCO2
10. Standardise and improve salience of monitor displays.
11. interprofessional team training to implement these guidelines
(they don't use the term sociotechnical but it's sociotechnical)
🙏
9. Remove ETT if
- OI cannot be excluded
- No sustained ETCO2
- SpO2 falls before restoring ETCO2
10. Standardise and improve salience of monitor displays.
11. interprofessional team training to implement these guidelines
(they don't use the term sociotechnical but it's sociotechnical)
🙏
Hypotensive vented patient, no echo available.
Sharad Patel, MD (@msmsharad) from ResusX:2026:
Did you know your vent screen is already tracking a volume responsiveness signal? A greater than 5% EtCO2 rise = fluid responder. How do you use this at your bedside? Comment below.👇
Sharad Patel, MD (@msmsharad) from ResusX:2026:
Did you know your vent screen is already tracking a volume responsiveness signal? A greater than 5% EtCO2 rise = fluid responder. How do you use this at your bedside? Comment below.👇
September 30, 2026 at 5:03 PM
Hypotensive vented patient, no echo available.
Sharad Patel, MD (@msmsharad) from ResusX:2026:
Did you know your vent screen is already tracking a volume responsiveness signal? A greater than 5% EtCO2 rise = fluid responder. How do you use this at your bedside? Comment below.👇
Sharad Patel, MD (@msmsharad) from ResusX:2026:
Did you know your vent screen is already tracking a volume responsiveness signal? A greater than 5% EtCO2 rise = fluid responder. How do you use this at your bedside? Comment below.👇
Sure, except all our traditional training is built around ensuring patients are ventilating adequately *before* we leave for PACU.
In my view EtCO2 should be available in PACU on a prn basis but not applied routinely unless our emergence standards have dropped.
In my view EtCO2 should be available in PACU on a prn basis but not applied routinely unless our emergence standards have dropped.
July 16, 2025 at 1:42 AM
Sure, except all our traditional training is built around ensuring patients are ventilating adequately *before* we leave for PACU.
In my view EtCO2 should be available in PACU on a prn basis but not applied routinely unless our emergence standards have dropped.
In my view EtCO2 should be available in PACU on a prn basis but not applied routinely unless our emergence standards have dropped.
EtCO2 increases with CO because of a reduction in dead space. Better perfusion to ventilated alveolar units, means more CO2 diffusing to be exhaled.
There is a ceiling effect as CO increases and V/Q matching is optimal. EtCO2 will never exceed PaCO2 (although can in funny situations)
1/2
There is a ceiling effect as CO increases and V/Q matching is optimal. EtCO2 will never exceed PaCO2 (although can in funny situations)
1/2
October 30, 2025 at 9:10 PM
EtCO2 increases with CO because of a reduction in dead space. Better perfusion to ventilated alveolar units, means more CO2 diffusing to be exhaled.
There is a ceiling effect as CO increases and V/Q matching is optimal. EtCO2 will never exceed PaCO2 (although can in funny situations)
1/2
There is a ceiling effect as CO increases and V/Q matching is optimal. EtCO2 will never exceed PaCO2 (although can in funny situations)
1/2