Question

ALS and EMS providers are preparing to hyperventilate a patient who has a suspected brainstem herniation. As capnography becomes available, what should be the target end-tidal carbon-dioxide level during hyperventilation?

A. 20-25 mmHg
B. 60-70 mmHg
C. 30-35 mmHg
D. 40-45 mmHg

Answer 1

The target end-tidal CO₂ level during hyperventilation for a patient with suspected brainstem herniation should be 30-35 mmHg. This range helps reduce intracranial pressure while avoiding the risks of excessive hypocapnia, which can lead to cerebral ischemia.

Step-by-step explanation:

When ALS and EMS providers are preparing to hyperventilate a patient with a suspected brainstem herniation, monitoring end-tidal CO₂ (ETCO₂) levels is crucial. The target ETCO₂ level during hyperventilation for brainstem herniation should be in the range of 30-35 mmHg. This hyperventilation technique is intended to reduce intracranial pressure by causing vasoconstriction from the resultant decrease in CO₂ levels. Hyperventilation leads to a state of hypocapnia, which is abnormally low blood levels of CO₂. This contrasts with hypercapnia, or abnormally elevated blood CO₂ levels, which can result from impaired respiratory functions or hypoventilation due to various causes. Hyperventilation should be carefully managed with capnography to avoid excessive reduction of CO₂ that can lead to cerebral ischemia. Thus, hyperventilating to achieve an ETCO₂ level of 30-35 mmHg is important for therapeutic management in the case of brainstem herniation while avoiding potential hyperventilation complications.