Capnography for EMT-B, a useful tool?

[beaucait]

Capnography has been said to be useful, but its not in Maine EMS protocol for basics. There is nothing wrong with reading a waveform if you are trained to do so. What do you think? Is it helpful? What scenario would you think this to be most helpful? Where do you think it would not be useful? Do you think BLS should use it every call? Could using waveform interpretations at the BLS level save medics some work? I mean we are all in this together.

 

[Jim37F]

Considering SpO2 pulse oximetery monitoring isn't even universally in BLS protocols, I'd sooner start there vs trying to get capnogrophy added....heck there's still some BLS transport services without AEDs even!

But otherwise, it's a noninvasive monitoring system, and has value, and isn't hard to learn....so I don't see why it can't be added..

 

[beaucait]

Considering SpO2 pulse oximetery monitoring isn't even universally in BLS protocols, I'd sooner start there vs trying to get capnogrophy added....heck there's still some BLS transport services without AEDs even!

But otherwise, it's a noninvasive monitoring system, and has value, and isn't hard to learn....so I don't see why it can't be added..

I mean I do come from a non-transporting EMS service... we gotta have something to play with on the monitor.

I think in some situations with one should come the other. The SpO2 only measures how much of whatever is attached to the blood... whether it be CO2 or O2 it doesn't discriminate. If we added caponography it might give us an edge to determine if there is CO2 retention or not...

but I'm just a basic what do I know?

 

[Gurby]

The SpO2 only measures how much of whatever is attached to the blood... whether it be CO2 or O2 it doesn't discriminate. If we added caponography it might give us an edge to determine if there is CO2 retention or not...

but I'm just a basic what do I know?

Also $$$$$$$$$$$$$$$$$$$$$$$

But I agree that capnography is the bomb.

 

[VentMonkey]

Capnography has been said to be useful, but its not in Maine EMS protocol for basics. There is nothing wrong with reading a waveform if you are trained to do so. What do you think?

Define “trained to do so”.

Is it helpful?

Yes, with the right patient it is an extremely useful diagnostic tool.

What scenario would you think this to be most helpful?

Any scenario in which ventilatory status can be indicative of an outcome, is compromised, and/ or can be utilized to guide your differential diagnosis. Since you’re the basic asking us, why don’t you tell us where you’d use it?

Do you think BLS should use it every call?

Absolutely not, nor should every paramedic.

Could using waveform interpretations at the BLS level save medics some work?

Eh, no more than it saves work for hospital staff when it’s performed by paramedics.

Again, the prudent clinician realizes and appreciates its value and can allow it to guide them down the proper treatment algorithms.

The SpO2 only measures how much of whatever is attached to the blood... whether it be CO2 or O2 it doesn't discriminate.

SPO2 gives a somewhat hindered value of oxygenated Hgb. CO2 doesn’t have a whole lot to do with oxygenation, and is indicative of a patient’s ventilatory status. This may or may not be hindered by several factors (e.g., underlying medical conditions be it metabolic, respiratory, or anything in between).

SPO2= oxygenation; CO2= ventilation. A relevantly important distinction.

“Something to play with” is absolutely not the right reason to ask for an expanded scope without understanding the value of said diagnostic tool. This goes for all of us and does our respective field no justice in general.

I’m not saying EMT’s shouldn’t be allowed to understand, play with, or have ETCO2 monitoring, but perhaps a biiit more education is needed at the entry level to a basics training before this is universally adopted.

 

[E tank]

How would it change what you do for the patient that you wouldn't do from your physical exam?

 

[CALEMT]

I'm all for EMT's having cool tools to do the job such as capnography. But in what scenario(s) would you use this in? Would it make your treatment any different at the BLS level? I don't know your protocols and what you can and can't do for treatments. Like others have said it's a great tool to see the pt's ventilatory status and can affect treatments at the ALS level. It's a great tool thats relatively easy to learn, but an expanded knowledge of capnography and the pathophysiology behind ventilation is needed.

 

[NomadicMedic]

I could see it being used a predictive tool for ROSC during a BLS resuscitation, but aside from that, not particularly useful in the BLS world.

Having said that, I’d rank capno as one of te top 5 EMS innovations of the last 20 years.

 

[EpiEMS]

Capnography is basically required for ETI, right? Wouldn’t it be necessary for SGAs?

OP, are you guys dropping Kings, Combis?

 

[VentMonkey]

Capnography is basically required for ETI, right? Wouldn’t it be necessary for SGAs?

Yep, but why not BVM as well?

 

[EpiEMS]

Yep, but why not BVM as well?

Absolutely - it's the gold standard for measuring real-time efficacy of our artificial ventilation. That said, never seen a BLS agency (without SGAs) that had ETCO2 monitoring capability.

If I were in charge (here's hoping), I'd make SpO2 and ETCO2 mandatory for BLS - it really does help us bag better! (Though I've only used ETCO2 to guide my BVM use on an intubated patient.)

 

[VentMonkey]

@EpiEMS you’re not quite the “typical” basic.

Now- I don’t mean this as an insult, and I will readily admit that as a tech I would have been ill-prepared to understand its true value. But again, without understanding the ins and outs of both oxygenation and ventilation as well as where, how, and when to implement such tools to their fullest potential, would it be worth said agency’s investment to allow their BLS providers to carry them?

Clearly, it’s of great benefit to the patient and provider for reasons you’ve pointed out, but when it’s just seen as a “cool tool” to play with would you agree that your peers in general are ready to understand and appreciate its capabilities, let alone allow it to guide the therapies that they’d provide?

And why not in-line ETCO2 NC’s as well? But again, are—or will—they being implemented to the right patient, at the right time, for the right reasons and not just applied blindly to every patient (shakes head)?...**ahem**c-spine anyone?

 

[Alan L Serve]

It's outside the scope of EMT Basics.

 

[Alan L Serve]

SPO2= oxygenation; CO2= ventilation. A relevantly important distinction.

Go back to school and learn what ventilation vs respiration is. That is a relatively much more important distinction.

 

[CALEMT]

Go back to school and learn what ventilation vs respiration is. That is a relatively much more important distinction.

Ummmmm you are aware that SpO2 is infact oxygenation and CO2 is ventilation right?

 

[Alan L Serve]

Ummmmm you are aware that SpO2 is infact oxygenation and CO2 is ventilation right?

Production of CO2 is not ventilation. It's respiration. A subtle but important distinction.

 

[VentMonkey]

For simplicity’s sake I referred to both so that the OP could keep in mind the distinction between the two: SPO2 and CO2 respectively.

While you may have a point @Alan L Serve, given your history on here I’m not feeding into your posts. And last time I checked, CO2 is a byproduct of the respiratory system and their mechanics (i.e., ventilation).

 

[Alan L Serve]

For simplicity’s sake I referred to both so that the OP could keep in mind the distinction between the two: SPO2 and CO2 respectively.

While you may have a point @Alan L Serve, given your history on here I’m not feeding into your posts. And last time I checked, CO2 is a byproduct of the respiratory system.

CO2 is part of respiration, not ventilation. It's very surprising anyone claiming to be a paramedic would make such a novice and rookie mistake. As for your off-topic personal attacks I shall simply ignore them.

 

[E tank]

Production of CO2 is not ventilation. It's respiration. A subtle but important distinction.

Reducing cellular respiration to the production of CO2...edgy...subtle isn't the word I'd use...

 

[VFlutter]

CO2 is part of respiration, not ventilation. It's very surprising anyone claiming to be a paramedic would make such a novice and rookie mistake. As for your off-topic personal attacks I shall simply ignore them.

Semantics. Respiration does not happen to any significant degree without ventilation. Unlike oxygens ability to easily diffuse CO2 requires convection and dead space ventilation.