End-Tidal Monitoring Log Form
Record end-tidal CO2 monitoring events and related clinical observations.
Patient Identifier (e.g., Room or Bed Number)
*
Date and Time of Monitoring
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Reason for Monitoring
*
Routine Assessment
Change in Clinical Status
Procedure Monitoring
Resuscitation
Other
Initial EtCO2 Reading (mmHg)
*
Final EtCO2 Reading (mmHg)
*
Ventilation Status
*
Spontaneously Breathing
Bag-Valve-Mask Ventilation
Mechanical Ventilation
Other
Device Used
*
Please Select
Mainstream Capnograph
Sidestream Capnograph
Colorimetric Device
Other
Any Interventions Performed?
*
Airway Adjustment
Oxygen Administration
Medication Given
Suction Performed
No Intervention
Other
Other Vital Signs (e.g., Pulse, SpO2, BP)
Staff Initials
*
Observations or Comments
Submit Log Entry
Should be Empty: