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You are here: Home / squirts / Error in capnography infographic

Error in capnography infographic

May 12, 2021 by Josh Farkas 1 Comment

Question:  What is the error in this infographic?

According to the infographic, cardiac arrest causes a sudden complete loss of waveform.  This isn't correct.  Cardiac arrest will cause a prompt downtrending etCO2 tracing (the pattern shown in the bottom right box).

This is clinically important because if a patient in cardiac arrest is intubated, there should be some waveform capnography tracing present.  The etCO2 will often be very low (e.g. 5-10 mm), but a tracing should be seen.  If a completely flat trace occurs, the endotracheal tube is probably in the esophagus.  Other possibilities may include a disconnection in the ventilator tubing or a dysfunctional etCO2 sensor (ideally the sensor was tested prior to intubation).

But the key point is that a completely flat etCO2 tracing should be assumed to indicate a misplaced endotracheal tube until proven otherwise.  This is taught in airway management using the mantra “no trace, wrong place.”

For more on this, take a look at the Royal College of Anaesthetists  “no trace, wrong place” campaign.  Yup, it's a campaign.  Who knew?

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Comments

  1. James Johnson says

    July 30, 2022 at 22:17

    Late to the party and hate to play the “what ifs”, but what if non-invasive end tidal monitoring is in place? That’s the only scenario I envision.

    Reply

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