Cluster Headache: Oxygen Saturation and End-Tidal CO2 During and Without Attack

Abstract Background During general anesthesia especially when the nurse or anesthesiologist forgets to change manual to controlled mode after successful endotracheal intubation, capnography shows End-tidal Co2 above 20 mmHg after checking the place of the tracheal tube and will remain on the screen permanently. In this scenario, the patient receives a high concentration of oxygen, and Spo2 (oxygen saturation) does not drop for a long time which is too late to intervene. It has been all-time questionable which one of the cardiac dysrhythmias or Spo2 dropping occurs earlier. Results Medical records of seven deceased patients reviewed. All of them had electrocardiogram changes including premature ventricular contraction or bradycardia as a first warning sign. Oxygen saturation remains above 95% even with cardiac dysrhythmia. Conclusions Bradycardia and premature ventricular contraction were the first warning findings for severe hypercapnia during general anesthesia and occurred earlier than dropping oxygen saturation. Furthermore, the normal capnography waveform is more reliable than the End-tidal Co2 number for monitoring.

Download Full-text

Cardiovascular and ventilatory response to isocapnic hypoxia at sea level and at 5,050 m

Journal of Applied Physiology ◽

10.1152/jappl.1996.80.5.1724 ◽

1996 ◽

Vol 80 (5) ◽

pp. 1724-1730 ◽

Cited By ~ 21

Author(s):

G. Insalaco ◽

S. Romano ◽

A. Salvaggio ◽

A. Braghiroli ◽

P. Lanfranchi ◽

...

Keyword(s):

Oxygen Saturation ◽

Sea Level ◽

Minute Ventilation ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Ventilatory Responses ◽

Hypoxic Conditions ◽

Progressive Hypoxia ◽

End Tidal ◽

End Tidal Co2

To assess the effect of chronic hypoxic conditions on ventilatory, heart rate (HR), and blood pressure (BP) responses to acute progressive isocapnic hypoxia, we studied five healthy Caucasian subjects (3 men and 2 women). Each subject performed one rebreathing test at sea level (SL) and two tests at the Pyramid laboratory at Lobuche, Nepal, at the altitude of 5,050 m, 1 day after arrival (HA1) and after 24 days of sojourn (HA2). The effects of progressive isocapnic hypoxia were tested by using a standard rebreathing technique. BP, electrocardiogram, arterial oxygen saturation, airflow and end-tidal CO2 and O2 were recorded. For each subject, the relationships between arterial oxygen saturation and HR, systolic BP and minute ventilation (VE), respectively, were evaluated. At HA1, the majority of subjects showed a significant increase in VE and BP response and a decrease in HR response to progressive isocapnic hypoxia as compared to SL. At HA2, VE and BP responses further increased, whereas the HR response remained similar to that observed at HA1. A significant relationship between hypoxic ventilatory responses and both systolic and diastolic BP responses to progressive hypoxia was found. No significant correlation was found between hypoxic ventilatory and HR responses.

Download Full-text

Physiological Impacts of Personal Protective Equipment on Health Care Workers

The Indonesian Journal of Occupational Safety and Health ◽

10.20473/ijosh.v10i1.2021.1-5 ◽

2021 ◽

Vol 10 (1) ◽

pp. 1

Author(s):

Anum Arif ◽

Ahsin Manzoor Bhatti ◽

Akhter Hussain ◽

Mohammad Tariq ◽

Osama Hadi ◽

...

Keyword(s):

Blood Pressure ◽

Health Care ◽

Oxygen Saturation ◽

Respiratory Rate ◽

Health Care Workers ◽

Personal Protective Equipment ◽

Protective Equipment ◽

Care Workers ◽

End Tidal ◽

End Tidal Co2

Introduction: Since the outbreak of the Ebola virus, its design has constantly been evolving to serve the purpose of protection without hampering the efficiency. In a study conducted in 2019, before the advent of COVID 19, it was found that performing precarious laboratory or clinical works while wearing PPE involved various restrictions compared to the same work without PPE. The objective of this study is to identify the influence of personal protective equipment on physiological parameters and the individual wellbeing of healthy workers. Methods: This Pilot Quasi-experimental study was performed on 12 volunteers fitting the inclusion criteria. Candidates were seated comfortably and their baseline resting pulse rate, respiratory rate, oxygen saturation via pulse oximeter, blood pressure, and End-tidal CO2 were recorded via a portable monitor. All candidates were asked to wear a KN95 mask along with a 3 ply mask over it and wear anti-fog goggles. All the above-mentioned parameters were recorded again after five minutes of comfortable sitting and ten minutes of brisk walk. Result: Significant difference is found between resting EtCO2 and after wearing of PPE (P = 0 .044). After a brief exercise, the further rise in EtCO2 is also significant (P = 0.002). There is no significant rise in pulse after wearing PPE (P = 0.092) but on exertion after wearing PPE, the rise in pulse is statistically significant (P = 0.002). The rest of the variables, such as the rise in respiratory rate, blood pressure, and fall in oxygen saturation rise has no statistical significance. Conclusion: Personal protective equipment has proven to rise in end-tidal carbon dioxide and tachycardia, which can lead to headache, dizziness, and respiratory discomfort. All of the factors can hamper the health care workers' performance and can adversely affect their efficiency.Keywords: covid-19, end tidal CO2, personal protective equipment, physiological

Download Full-text

Cardiorespiratory Functioning in Youth with Persistent Post-Concussion Symptoms: A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10040561 ◽

2021 ◽

Vol 10 (4) ◽

pp. 561

Author(s):

Aliyah Snyder ◽

Christopher Sheridan ◽

Alexandra Tanner ◽

Kevin Bickart ◽

Molly Sullan ◽

...

Keyword(s):

Processing Speed ◽

Mean Value ◽

Exhaled Breath ◽

Post Injury ◽

The Past ◽

Neurobehavioral Outcomes ◽

End Tidal ◽

Relationship Of ◽

The Relationship ◽

End Tidal Co2

Dysregulation of the autonomic nervous system (ANS) may play an important role in the development and maintenance of persistent post-concussive symptoms (PPCS). Post-injury breathing dysfunction, which is influenced by the ANS, has not been well-studied in youth. This study evaluated cardiorespiratory functioning at baseline in youth patients with PPCS and examined the relationship of cardiorespiratory variables with neurobehavioral outcomes. Participants were between the ages of 13–25 in two groups: (1) Patients with PPCS (concussion within the past 2–16 months; n = 13) and (2) non-injured controls (n = 12). Capnometry was used to obtain end-tidal CO2 (EtCO2), oxygen saturation (SaO2), respiration rate (RR), and pulse rate (PR) at seated rest. PPCS participants exhibited a reduced mean value of EtCO2 in exhaled breath (M = 36.3 mmHg, SD = 2.86 mmHg) and an altered inter-correlation between EtCO2 and RR compared to controls. Neurobehavioral outcomes including depression, severity of self-reported concussion symptoms, cognitive catastrophizing, and psychomotor processing speed were correlated with cardiorespiratory variables when the groups were combined. Overall, results from this study suggest that breathing dynamics may be altered in youth with PPCS and that cardiorespiratory outcomes could be related to a dimension of neurobehavioral outcomes associated with poorer recovery from concussion.

Download Full-text