I guess if you have tons of time to spend on scene you can do all the labs which will have to be repeated in the hospital.
Or by iStat. That said, CCT is not about speed. I've run two hour scene times on CCT IFTs before, it took that much to be able to move safely.
You mention PaCO2. That value is from the artery. That is what the a stands for.
Got that, I've looked at ABGs once or twice
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The gradient won't be the same since venous blood will give you a different value and you'll be chasing the wrong number.
Unless there is a change in hemodynamics or alveolar status, the PaCO2 to ETCO2 remains the same. So if there's a PaCO2 of 60 and an ETCO2 of 55, it will be 40 and 35 respectively after changes.
I also can not think of one state that allows Paramedics to stick arteries in the field.
Not all of us are bound by what a state EMS administrator thinks we need to be doing. You can also draw off an a-line.
Some of us know our limitations for scope of practice and feel a patient is best served with some of these procedures done in a hospital simultaneouly with a lot of the other tests to get the patient the best care.
Sometimes your giving your patient a death sentence by not optimizing them for transport. There is a time to fish or cut bait. However, taking a truly mismanaged CCM patient (and it happens more often than you think) and throwing them in the truck where you don't have the help, equipment or room to work without trying to at least start correcting the issues is negligent.
The heart and brain are not that forgiving.
Hence why CCT is a distinct discipline.
Most ALS crews don't have fancy ICU ventilators with alot of knobs and the training hasn't caught up to alot of lab interpretation.
The training needs to. Furthermore, ALS crews don't need to be doing ICU to ICU trips.
Maybe we should figure out how to improve intubation since a King or Combi isn't going to work that well with a ventilator either.
You lost me here. The will work short-term with a vent as well as an Ambu bag. Maybe better, because the breath is delivered in a far more controlled manner.
To the others, if you aren't going to correct with some pharmacology, what is the point of doing all the labs? Basic vent instruction also told us that you can chase numbers with a vent just so long and you do more damage than good.
Knowing is sometimes half the battle. Some of us also carry the pharmacology to correct a lot of this.
I'm not sure where you took CCEMT-P. It doesn't sound like you were taught by true subject matter experts though, rather by someone who had a tenuous grasp of the material.