# Co2



## yowzer (Dec 23, 2006)

I had my first experience with cagnography yesterday.

Working on a CCT car with a nurse, and a brand new, all the bells and whistles LP12. Our patient's a guy who had a morphine pump surgically implanted a few days ago. The general consensus is that its dosage is a bit too high. On a steady narcan drip, he's alternating between being perfectly lucid and zonked out. Turn off the IV pump, and he's out within seconds. Turn it on again, and he's back awake just as fast. It was pretty impressive.

Anyways, when the morphine overpowered the narcan, he sometimes stopped breathing.  Looking at the capnography display, it was easy to predict when he'd go under and hav a BVM ready to give him a few puffs of air until he started breathing again -- his CO2 output would start dropping, the waveforms deteriorate, way before his O2 saturation started dropping. When he was ventilated, you could see spikes on the monitor, and then the return to normal as he woke up again.

It was pretty nifty. I wish we had it on BLS cars, but I don't see that happening anytime soon because of the cost...


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## YYCmedic (Dec 23, 2006)

Cool, transfer calls are fun. Except if your pt. randomly starts tanking on you. But its good that it was an easy fix.


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## MeaganIV (Dec 23, 2006)

well like mr TJ asked me, endtitle co2 isn't usually used with BVMs except for DKA and stuff..


I don't see why not though.  Its nothing too fancy. Just gotta identify colours.


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## Ridryder911 (Dec 23, 2006)

EtC02 can be used in all respiratory cases. It is a great tool for diagnostics between CHF and Obstructive diseases such as COPD & Asthma. If one uses sidestream (looks like a nasal cannula). Very true that it can be used for patients in DKA. 

More and more research is revealing that "non-workable" patients can be made by EtC02 numbers by simply attaching the adapter to an BVM and bagging about 6 times (wash out Co2) and then obtaining the number. More research is being obtained, but I do look for this to be another way of field termination on codes. 

The nice thing about EtC02 is it can be used on neonate to adults and there is no interference such as in seizures, etc.. the wave form will still be smooth. As well it is one of the few detectors that can be used in a possible WMD attack using gases. 

I predict within 5 years, all units will have EtC02 in addition to Sp02. Actually EtC02 is more beneficial than the SP02 device. 

The main difference is EtC02 monitors the respiratory system where as the Sp02 measures oxygen absorption, two distinct differences. 

Yes, one have a decreased wave form for up to 4 minutes prior to Sp02 detecting it due to the time hypoxia has to occur... so, see the value of it ?

They are making new models with ranges made on them for basic levels, and from what I understand, the new basic curriculum is considering teaching it in the new program. 

R/r 911


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## jeepmedic (Dec 23, 2006)

I wanted it for our new monitors at the Fire Dept. but cost around 9-10k extra. So being a Volly Dept. we could not afford it. But is is great. I want it.


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## MeaganIV (Dec 23, 2006)

ETCO2 has been added to the vitals of the intermediates too.  Skin color/condition, LOC, PEARRL, resps, pulse, temp., BP, BGL, SpO2, ECG, and ETCO2....



I don't think you can add it onto an NRB though...


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## Guardian (Dec 23, 2006)

a decent website that will take you 3 mins to read... http://medicscribe.blogspot.com/2006/05/10-things-every-paramedic-should-know.html


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## Ridryder911 (Dec 24, 2006)

If you would like to learn how to read and mearn more about capnography here is a free site:

http://www.capnography.com

R/r 911


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## yowzer (Dec 24, 2006)

MeaganIV said:


> ETCO2 has been added to the vitals of the intermediates too.  Skin color/condition, LOC, PEARRL, resps, pulse, temp., BP, BGL, SpO2, ECG, and ETCO2....
> 
> 
> 
> I don't think you can add it onto an NRB though...



Disconnected cannula with an attached sensor under the mask seems to work well enough.


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## MeaganIV (Dec 24, 2006)

No kidding.  


I only think i'd use it on an unconsciouse pt that I'm ventilating.


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> No kidding.
> 
> 
> I only think i'd use it on an unconsciouse pt that I'm ventilating.



You have been trained on it but not educated on the uses of CO2 monitoring. It has alot of uses other than a play toy on some that is no longer breathing on there own. Check out Bob Page's class "Riding the Waves"


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## Fedmedic (Dec 24, 2006)

jeepmedic said:


> Bob Page's class "Riding the Waves"



Oh no, another disciple. Bob Page-the best damn salesman I know!! LOL


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## jeepmedic (Dec 24, 2006)

Fedmedic said:


> Oh no, another disciple. Bob Page-the best damn salesman I know!! LOL



But you got to admit he is entertaining


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## Airwaygoddess (Dec 24, 2006)

It is a pretty amazing piece of equipment!!!


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## Flight-LP (Dec 24, 2006)

MeaganIV said:


> ETCO2 has been added to the vitals of the intermediates too.  Skin color/condition, LOC, PEARRL, resps, pulse, temp., BP, BGL, SpO2, ECG, and ETCO2....
> 
> 
> 
> I don't think you can add it onto an NRB though...



Actually, ETCO2 monitoring is available for both NRB's and NC's. I routinely use it, especially with my COPD'rs. Provides an excellant "rough guestimate" baseline of where they are and where they are potentially going!


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## MeaganIV (Dec 24, 2006)

that really would be... 


I'm gonna have to check these gadgets out.


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## jeepmedic (Dec 24, 2006)

Why worry about CO2 when you can't intubate?


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## MeaganIV (Dec 24, 2006)

jeepmedic said:


> Why worry about CO2 when you can't intubate?



You know, we discuss things, put in our two cents and listen to what others have to say.  No where in the world does it say you have to listen and be bitter about my disagreeing with you.  It will happen.  People disagree all the time.  

Again, just because I don't like that doesn't mean that you can't do it.  take it in stride.  Don't be so bitter about it.  It's not that big of a deal.


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## MeaganIV (Dec 24, 2006)

jeepmedic said:


> Why worry about CO2 when you can't intubate?



Besides, intubation isn't always required when End Tidal CO2 is.


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## trauma1534 (Dec 28, 2006)

Fedmedic said:


> Oh no, another disciple. Bob Page-the best damn salesman I know!! LOL



Bob Page is THE ****!!!


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## trauma1534 (Dec 28, 2006)

MeaganIV said:


> You know, we discuss things, put in our two cents and listen to what others have to say.  No where in the world does it say you have to listen and be bitter about my disagreeing with you.  It will happen.  People disagree all the time.
> 
> Again, just because I don't like that doesn't mean that you can't do it.  take it in stride.  Don't be so bitter about it.  It's not that big of a deal.



Lots of times we must do things in the field that we don't like.  Intubation is not a matter of weather you like it or not, it is a necessity tool of the trade!  If you are an I and don't find it important enough to secure your patient's airway, then you might as well drop back to a B, however EMT-B's intubate also... I guess that would mean that you would need to be a First Responder so that you would not have to be held responsable for intubations.

By the way... how long have you been in EMS and how long have you been an ALS provider?  Just curious...


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## Ridryder911 (Dec 28, 2006)

trauma1534 said:


> Lots of times we must do things in the field that we don't like.  Intubation is not a matter of *weather* you like it or not, it is a necessity tool of the trade!  If you are an I and don't find it important enough to secure your patient's airway, then you might as well drop back to a B, however EMT-B's intubate also... I guess that would mean that you would need to be a First Responder so that you would not have to be held responsable for intubations.
> 
> By the way... how long have you been in EMS and how long have you been an ALS provider?  Just curious...



Actually intubation is NOT part of the national Basic EMT curriculum. As well there are more states that do NOT allow Basics to intubate than allow them to. That is why they are called basics... other wise most would call them advanced. 
I am curious though when you intubate how long to do you pre-oxygenate prior to intubation attempts?
p.s.... weather is a meteorological term ..lol 

R/r 911


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## Guardian (Dec 29, 2006)

trauma1534 said:


> Lots of times we must do things in the field that we don't like.  Intubation is not a matter of weather you like it or not, it is a necessity tool of the trade!  If you are an I and don't find it important enough to secure your patient's airway, then you might as well drop back to a B, however EMT-B's intubate also... I guess that would mean that you would need to be a First Responder so that you would not have to be held responsable for intubations.
> 
> By the way... how long have you been in EMS and how long have you been an ALS provider?  Just curious...



There you go again trying to portray yourself as an expert because you have more "experience" than some other people on this forum.  Is it possible for a John Doe MD, FACS, FACEP, PH.D, MS, MS, MS, CCRN, CCEMT-P, FP-C, MICP, to have a debate with Jane Doe (attending CPR class) and lose that debate to her because he's wrong? YES!!!!!


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## Ridryder911 (Dec 29, 2006)

If it is solely based upon experience.. I am afraid my resume and bad knees and back might win... I will be celebrating my 30'th year in the field this coming year. Anyone want to compare Registry numbers ? LOL ...

R/r 911


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## Airwaygoddess (Dec 29, 2006)

Wait! I hear the sound of stone tablets and Rid's turbo charged wheelchair! ^_^  Just teasing, I agree that ET intubation is an ALS skill.  One must understand the theory behind the skill.  So Rid, how many numbers on your parmedic cert?


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## ffemt8978 (Dec 29, 2006)

Airwaygoddess said:


> So Rid, how many numbers on your parmedic cert?


My guess is one...I heard he worked his first code on the Ark.


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## Ridryder911 (Dec 29, 2006)

Yeah, my first drowning victim...LOL I put it this way my original card was less than 10,000 for my basic registry. (Remember NREMT did not have a Paramedic level until 1982) So everyone took the NREMT- A (ambulance)  and then took a Paramedic course and maybe a local Paramedic test.. wham you were a Paramedic. 

They changed everyone Paramedic numbers about 10 years ago so there is no low numbers any more. 

Funny, I am not that old.. I just started when I way too young. (seriously) I had performed my first code in the field & defib when I was 16. We were two of the only Paramedic services in the state. So bringing a patient in to an ER with an IV was never heard of. There was fights among nurses and EMT's all the time (ironic most of the nurses in ER were LPN's). 

We have came great strides in some areas and still lacking in others.. that is why I am so passionate in getting things changes. I never want to see us regress. Many people have paid multiple of sacrifices to have EMS where it is today... 

R/r 911


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## fyrdog (Dec 30, 2006)

While ET tubes are a tool of the trade I disagree that they are a necessity. I was working with another paramedic one day on a code and he said he didn't know if the tube was in right but kept it in and used it. I got him to switch with me so I could double check it and ended up pulling it because it was definitly not in. I wasn't able to be sure 100% I could get it either so we ended up with an OPA and BVM. He had chest rise and lungs sounds with the BLS airway not with the ET tube. Neither one of us heard anything bad about our descion expecially since aneistesia had a heck of time getting it in the ER.

I was taught that a BLS airway is better than an uncertain ET Tube.


Sorry about all the spellin errors.



Ridryder911 didn't you do that water rescue with that little kid in reed basket? I think his name was moses.


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## Guardian (Jan 1, 2007)

fyrdog said:


> While ET tubes are a tool of the trade I disagree that they are a necessity. I was working with another paramedic one day on a code and he said he didn't know if the tube was in right but kept it in and used it. I got him to switch with me so I could double check it and ended up pulling it because it was definitly not in. I wasn't able to be sure 100% I could get it either so we ended up with an OPA and BVM. He had chest rise and lungs sounds with the BLS airway not with the ET tube. Neither one of us heard anything bad about our descion expecially since aneistesia had a heck of time getting it in the ER.
> 
> I was taught that a BLS airway is better than an uncertain ET Tube.
> 
> ...





sounds like you needed capnography in this case.


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## jeepmedic (Jan 1, 2007)

Ridryder911 said:


> Actually intubation is NOT part of the national Basic EMT curriculum. As well there are more states that do NOT allow Basics to intubate than allow them to. That is why they are called basics... other wise most would call them advanced.
> I am curious though when you intubate how long to do you pre-oxygenate prior to intubation attempts?
> p.s.... weather is a meteorological term ..lol
> 
> R/r 911



No one said anything about the National Curriculum. Also Intubation is taught in the Basic Class look in the EMT-B books. It is included in the back of the books as an add on. Also Basic Intubation is included in Virginia as an OMD option. Which means that if the OMD approves then an EMT-B can be taught intubation. Which is also the case for a Combi-tube.

As far as pre-oxygenating a pt prior to intubation it is 30-60 sec. and if you can't tube them within 20-30 sec. then you pull out and oxygenate them again for 30-60 sec.

Who cares about the weather?  lol


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## jeepmedic (Jan 1, 2007)

Ridryder911 said:


> Yeah, my first drowning victim...LOL I put it this way my original card was less than 10,000 for my basic registry. (Remember NREMT did not have a Paramedic level until 1982) So everyone took the NREMT- A (ambulance)  and then took a Paramedic course and maybe a local Paramedic test.. wham you were a Paramedic.
> 
> They changed everyone Paramedic numbers about 10 years ago so there is no low numbers any more.
> 
> ...



I thought you said you were never an EMT, that you were always a Paramedic.


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## trauma1534 (Jan 1, 2007)

jeepmedic said:


> I thought you said you were never an EMT, that you were always a Paramedic.



Nope... not Ridryder... NEVER an EMT!!!  That would be a discrase on his part for anyone to ever be able to figure out that he was not always the seen all known all Paramedic, NP, and whatever else his merrit badges says!!! LOL


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## Guardian (Jan 1, 2007)

it's disgrace


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## macinfire (Jan 4, 2007)

Our capnography is on our Zoll's, we should use it more often...  We had several really good classes when we first got it, but we need a refresher.  For us, just another tube placement indicator.  I know if I have a good visual, then most of the time I don't bother, unless it may be a prolonged tx, which is rare in the city  I am in.


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## jeepmedic (Jan 5, 2007)

macinfire said:


> Our capnography is on our Zoll's, we should use it more often...  We had several really good classes when we first got it, but we need a refresher.  For us, just another tube placement indicator.  I know if I have a good visual, then most of the time I don't bother, unless it may be a prolonged tx, which is rare in the city  I am in.



We still have to use the little color change thingie even though you should not place the tube without cord visulazation and poss. lung sounds without epigastric sounds.


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## Ridryder911 (Jan 5, 2007)

The "colored thingie" I presume is a colorimetric capnograhic device. The nice thing they are cheap and do work most of the time. The down side is that they are not effective if the patient has vomited, has ingested beer, cola, or has large amount of fluid in the lungs.. as well does not represent levels of EtCo2 and if there is obstruction versus retention levels. 

p.s. everyone that wanted to be NREMT had to take the EMT-Ambulance or non-ambulance test. There was not a NREMT Paramedic exam until 1980. One could already be a Paramedic though through local and state license/ certification prior to NREMT invention of levels. The intermediate was later designed in 1981. 

R/r 911


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