There is nothing more irritating than incompetent nurses...

[jjesusfreak01]

Funny story, I was doing IFT on the overnight, and we had to transfer a 2 y/o pt w/ pneumonia and RSV, who had observed periods of apnea (CA&O) . The sending RN said that she wishes they had a way to monitor the pt's respiratory rate.I explained that we can use ETCO2 with this pt to do just that. She was intrigued after I explained the NC device to her and how it works. I've yet to see ETCO2 used on conscious pt's that are not vented inside the hospital in this region. This troubles me.

The only time i've seen it used in the hospital outside of a code is when ortho is doing reductions under conscious sedation. I know anesthesiology uses it, but it really just isn't used very much. I guarantee you most EMT's that work in systems using capnography know more about it than 95% of nurses in any given hospital.

 

[DesertMedic66]

Funny story, I was doing IFT on the overnight, and we had to transfer a 2 y/o pt w/ pneumonia and RSV, who had observed periods of apnea (CA&O) . The sending RN said that she wishes they had a way to monitor the pt's respiratory rate.I explained that we can use ETCO2 with this pt to do just that. She was intrigued after I explained the NC device to her and how it works. I've yet to see ETCO2 used on conscious pt's that are not vented inside the hospital in this region. This troubles me.

We now (April 1st) have to start using ETCO2 on all our airway stuff. So now any patient on oxygen will have it.

 

[DrankTheKoolaid]

Advanced airway i hope you mean. Otherwise huge waste of money unless there is a reason to look that closely at a persons ventilitory status.

Dont get me wrong, I love ETCO2 and use it on all my advanced airway patients. Sidestream for asthma/copd/CHF i can see. But for anyone on O2? Little over kill i think.

 

[DesertMedic66]

The way they were making it sound, it's going to be every patient on O2

 

[TatuICU]

Advanced airway i hope you mean. Otherwise huge waste of money unless there is a reason to look that closely at a persons ventilitory status.

Dont get me wrong, I love ETCO2 and use it on all my advanced airway patients. Sidestream for asthma/copd/CHF i can see. But for anyone on O2? Little over kill i think.

Agreed, that's some serious coin for something that certainly not every pt on O2 needs.

 

[Handsome Robb]

We only have ETCO for advanced airways :-/ no sidestream. Flight service has it but it hasn't translated to our ground units left.

Like corky said, using ETCO on anyone receiving o2 seems to be overkill but if that's what the MD wants thats what the MD gets

 

[exodus]

Agreed, that's some serious coin for something that certainly not every pt on O2 needs.

If oxygen is actually clinically indicated how would having an ETCo2 + capnography not be beneficial? I doubt it will be required on patients with home O2, etc, unless their C/C is respiratory related.

 

[DrankTheKoolaid]

No argument there, Iffffffff it's indicated.

 

[exodus]

No argument there, Iffffffff it's indicated.

Our new protocol states to only give oxygen if it is clinically indicated, we'll see how that actually goes though.

 

[DesertMedic66]

Our new protocol states to only give oxygen if it is clinically indicated, we'll see how that actually goes though.

Oxygen for everyone

 

[ffemt8978]

Our new protocol states to only give oxygen if it is clinically indicated, we'll see how that actually goes though.

What?!!?! No more high flow O2 and high flow diesel for everyone?!? What are we to do now?

 

[Tigger]

Agreed, that's some serious coin for something that certainly not every pt on O2 needs.

If you're monitor already has the capability, is it really that pricy? I was under the impression that the nasal canula type measuring devices (forgive the vagueness in terminology, we don't have them where I work, just in the area) were really rather inexpensive (>$5).

 

[ffemt8978]

If you're monitor already has the capability, is it really that pricy? I was under the impression that the nasal canula type measuring devices (forgive the vagueness in terminology, we don't have them where I work, just in the area) were really rather inexpensive (>$5).

5 dollars per patient adds up pretty quick, especially if insurance and Medicare deem it unneccesary and won't reimburse for it.

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[Tigger]

5 dollars per patient adds up pretty quick, especially if insurance and Medicare deem it unneccesary and won't reimburse for it.

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If we are administering oxygen correctly in the first place, wouldn't it then be deemed necessary? If it can tell us that our oxygen therapy is providing a benefit, isn't it then reasonable?

 

[usalsfyre]

They're actually about $35 apiece, and can quickly become their own line item considering a normal NC is around a dollar.

 

[TatuICU]

If you're monitor already has the capability, is it really that pricy? I was under the impression that the nasal canula type measuring devices (forgive the vagueness in terminology, we don't have them where I work, just in the area) were really rather inexpensive (>$5).

Oh, ok. The last EMS company that I worked at that used those NCs with the adapters guarded them like they were dipped in gold and rolled in diamonds so i figured they were fairly expensive. Our monitors at the EMS company I work at now have the monitoring capability but we only have the ET tube adapters for it.

 

[TatuICU]

If we are administering oxygen correctly in the first place, wouldn't it then be deemed necessary? If it can tell us that our oxygen therapy is providing a benefit, isn't it then reasonable?

Yeah you're right, but typically those patients that need it will be getting ABGs drawn once they arrive at the ER anyway. Hey, there's an idea, ABGs on scene with the iStat machines.

Bottom line you are 100% correct that EMS companies should have them at their disposal, but if I were trying to cut costs as an admin, I probably wouldn't think too highly of them.

 

[TatuICU]

If oxygen is actually clinically indicated how would having an ETCo2 + capnography not be beneficial? I doubt it will be required on patients with home O2, etc, unless their C/C is respiratory related.

Because as it sits now, alot of EMS providers give O2 "just because" and not when it is actually clinically indicated.

 

[Veneficus]

Sounds to me like:

Rather than educate people to the proper use of oxygen and physicians not writing protocols for high flow oxygen on patients that would not benefit, ambulance operators are expected to pay more for a gadget to try and make up for poor training and medical direction.

I can't see why anyone would pay for this.

 

[mycrofft]

And where do we want the fulcrum for the prehospital-versus-in hospital care teeter-totter to shift to?
Will it be frequently enough used to support amortization and skill currency? Will short transport times in urban settings make its use superfluous?
But this is about us uppity nurses....