Waveforms Don't Lie - Danny and Rance (DnR)
Critical Levels19 Okt 2025

Waveforms Don't Lie - Danny and Rance (DnR)

In this episode, we explore the science, history, and frontline application of End-Tidal CO₂ (ETCO₂) — a tool that offers real-time insight into ventilation, perfusion, and metabolism. Danny and Rance from DnR explain how paramedics can use ETCO₂ to assess and guide care across multiple patient presentations.

Key Takeaways:

  • ETCO₂ is the sixth vital sign — reflecting ventilation, perfusion, and metabolism in real time.

  • Capnography vs. Oximetry: SpO₂ shows what was happening; ETCO₂ shows what's happening now.

  • Waveform interpretation: Alpha and beta angles reveal underlying pathology like bronchospasm, obstruction, or air trapping.

  • Clinical uses:

    • Tube confirmation: Real-time verification in 6 breaths or less.

    • CPR: Values <10 mmHg after 20 mins indicate poor prognosis.

    • Ventilation: Real-time feedback for rate and volume.

    • Head injuries: Maintain normocapnia; hyperventilate only during herniation.

    • Sepsis, trauma, PE, and DKA: Trending ETCO₂ helps identify metabolic and perfusion problems.

  • Practical tips:

    • "Filter first, end-tidal to the sky."

    • Inline sensors outperform sidestream for accuracy.

    • End-tidal is not just for intubated patients — use it with nasal prongs for sedation and respiratory monitoring.

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