Quiz-396-Section 2

Which of the following best distinguishes capnography from capnometry?

Distinction between capnography and capnometry

Capnography measures CO₂ concentration in mmHg, whereas capnometry displays the waveform.

Capnography provides real-time waveform analysis of the respiratory cycle, whereas capnometry provides only a numerical value.

Capnography is used exclusively for intubated patients, whereas capnometry is used for non-intubated patients.

Capnography measures end-tidal CO₂, whereas capnometry measures arterial CO₂.

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A paramedic uses a colorimetric CO₂ detector to confirm endotracheal tube placement in a patient in cardiac arrest. The device remains purple after six breaths. Which of the following is the most appropriate interpretation?

Limitations of colorimetric detectors

The device may be showing a false negative due to low pulmonary blood flow, and quantitative capnography should be used if available.

The tube is definitely in the esophagus and must be removed immediately.

The patient has no CO₂ production due to metabolic arrest, confirming the tube is in the trachea.

The colorimetric device has failed and should be discarded without further assessment.

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During a prolonged transport, the capnogram waveform becomes irregular, noisy, and intermittently flatlined, despite the patient maintaining a patent airway and adequate chest rise. Which of the following is the most likely cause?

Sidestream artifact

Complete obstruction of the endotracheal tube by a mucus plug.

Disconnection of the sampling line from the monitor.

Condensation accumulating in the sampling line or water trap.

Exhaustion of the CO₂ absorber in the breathing circuit.

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A patient with a severe asthma exacerbation presents with a capnogram showing a widened alpha angle (>130°) and a sloped Phase III plateau. What does this waveform morphology indicate?

Interpretation of a widened alpha angle

The patient is experiencing CO₂ rebreathing due to a faulty circuit.

The patient has developed a pneumothorax.

The patient is hyperventilating and blowing off CO₂ too rapidly.

The patient has heterogeneous alveolar emptying due to increased airway resistance.

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The capnogram of a mechanically ventilated patient shows a baseline that fails to return to zero (elevated Phase I) and an obtuse beta angle (>90°). Which of the following is the most appropriate immediate action?

Elevated beta angle and elevated baseline

Increase the ventilator rate to blow off the excess CO₂.

Inspect the breathing circuit for incompetent valves or an exhausted CO₂ absorber.

Administer a bronchodilator to treat suspected bronchospasm.

Switch the patient to a non-rebreather mask to improve oxygenation.

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Which of the following is a primary advantage of mainstream capnography compared to sidestream capnography?

Mainstream vs. Sidestream Sampling

Virtually no sampling delay and high waveform fidelity.

Compatibility with non-intubated patients using nasal cannulae.

Reduced mechanical dead space in the breathing circuit.

Lower susceptibility to water vapour artifacts.

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A hemodynamically stable, intubated patient with a previously normal EtCO₂ of 38 mmHg suddenly experiences a drop to 15 mmHg with no change in ventilator settings. Which of the following should the paramedic suspect first?

Interpretation of a sudden drop in EtCO₂

The patient is developing severe metabolic acidosis.

The patient is hypoventilating due to sedation.

A sudden loss of pulmonary perfusion or a circuit disconnect.

The patient has developed a severe bronchospasm.

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A patient receiving high-flow oxygen via a non-rebreather mask is monitored with a sidestream capnometer using a nasal cannula. The EtCO₂ reading is consistently 10 mmHg lower than expected, despite normal clinical signs. What is the most likely explanation?

Sampling artifacts

The patient is hyperventilating excessively.

The nasal cannula is obstructed by secretions.

The patient has a pulmonary embolism.

High-flow oxygen is diluting the sampled gas at the nasal port.

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During the transport of a sedated patient, the paramedic notices a distinct notch or cleft in the Phase III plateau of the capnogram. What does this finding most likely indicate?

The Curare Cleft

The patient is experiencing a seizure.

The patient is making a spontaneous inspiratory effort against the ventilator.

The ventilator is set to a rate that is too slow.

The endotracheal tube is partially obstructed by a mucus plug.

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A paramedic observes a sudden, complete loss of the capnogram waveform (flatline) in an intubated patient. Which of the following is the most appropriate initial step in the assessment algorithm?

Differential diagnosis

Immediately verify tube placement and check for circuit disconnection or obstruction.

Assume the patient has suffered a cardiac arrest and start CPR.

Increase the ventilator rate to attempt to clear the airway.

Administer bicarbonate to buffer potential metabolic acidosis.

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