In this follow-up episode, Bruce and the team continue their discussion on ventilation and airway management. This episode goes into much greater depth on how ETCO2 can be used to manage an array of patients effectively and how a thorough understanding and monitoring of end-tidal during a resuscitation attempt can help ensure a patient remains neurologically intact, assuming ROSC is achieved. Bruce covers case studies on this topic, and the team has the opportunity to look at the “oscillations” in end-tidal and how they provide vital information on the efficacy of CPR and PPVs. This episode provides unique insight and information on the delivery of effective ventilations and how to best use the tools in our toolbox to ensure our patients receive the highest possible level of care. This episode highlights the central theme of part 1: that airway management should not be lightly handed over to the least experienced provider; instead, thorough training should be provided to all members of a crew to ensure all are competent and understand the weight and importance of the delivery of effective ventilations to not only the management of the patient while they are in crisis, but to their longevity following the incident.

Below are graphics and their descriptions provided by Bruce to help understand concepts discussed in the course.

This example shows "Oscillations, 30:2 Ventilations. This patient is intubated (Patent Airway). Tidal Volume is excellent, and compressions look high quality. You can see it all play out.  Also, notice that in the 30:2, the first end-tidal waveform is shortened.  That is because we are trying to give 2 really fast breaths, so we interrupt the first breath out with an immediate 2nd breath in, giving it a shortened waveform.  This is trained at TVFR to give your two breaths and then look for a shortened waveform, and the 2nd breath has the compressions.  Appreciate how consistently our variables are working together, and the end-tidal is not wavering or all over the place."

- Bruce Opsal

The above example "Is a crew that gave the bonus breaths that I discussed in the podcast. Rhythm Change (Sinus Bradycardia), not perfusing, and the end-tidal drastically is dropping breath by breath.  You might think, if I give 4 stacked breaths, wouldn't that lower the end-tidal, and the answer is no.  You will not have a drastic change as that, where the first breath is around 50 and by their 5th breath, it's at 20.  I would argue that it will just outright sustain if the heart is perfusing.  A student contested this, so I just had him put on an end-tidal and a monitor and watched him dry to drop his capnometry even one point from 1 - 5 breaths, and he couldn't do it."

- Bruce Opsal