Capnography for EMT-B, a useful tool?

OREMT

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On our BLS truck we use ETCO2 as a diagnostic tool in our sepsis protocol. While monitoring ETCO2 won't necessarily change the care I provide this patient as an EMT-B, it does factor into my decision to request ALS or not. If I'm already transporting, an ETCO2 of <25 mmHg, plus other signs of infection, necessitates a sepsis alert notification to the ED. In this capacity I think ETCO2 is very helpful for the BLS provider.
 

NomadicMedic

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While I think ETCO2 may be nice to have as a basic (more toys, yay!) I don’t belive it’s necessary and may take the EMTs focus off more important tasks.

If you have interventions that can be steered by capno, then it’s useful. No basics I know of do. A “sepsis alert” precipitated by ETCO2 on a basic truck is next to useless. If you want to make an early call and if you’re thinking sepsis, you can clinically correlate your hunch with the Prehospital Early Sepsis Detection Score, and if you really want to get high speed, use the amended PRESEP score with glucose.

Oh wait, you don’t know about those? You don’t know how to use critical thinking to suss out a field impression? But you want ETCO2?

Uhh, no.

Drive to the hospital.
 

EmergencyMedicalSike

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This reminds me of a discussion a few of us had at our station. Nothing really stops basics from taking ACLS except maybe an ECG and pharm class and that’s pretty simple. So you have your ACLS card now and can interpret pretty basic cardiac rhythms. Does that mean EMT’s with ACLS should get to use monitors? Nope.
Although learning the bells and whistles of how a monitor works is pretty simple and you have knowledge of rhythms as a basic, there’s nothing in your scope of practice you can do if you spot an arrhythmia or other abnormal rhythms. Just like ETCO2, you can learn how to work with it and get good at it, but your scope doesn’t allow you to do s**t with it if the pt goes bad. So giving these things to basics is essentially a waste of money in the end.
 

EpiEMS

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but your scope doesn’t allow you to do s**t with it if the pt goes bad.

I gots' me an AED, I can fix two major problems right there.

but your scope doesn’t allow you to do s**t with it if the pt goes bad. So giving these things to basics is essentially a waste of money in the end.

Sure it does. I've got a BVM, some OPAs, some NPAs...it's the rare airway problem that I can't fix for a bit. And ETCO2 helps me to make sure I'm bagging correctly.

propermask-400x507.jpg
 

NomadicMedic

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This reminds me of a discussion a few of us had at our station. Nothing really stops basics from taking ACLS except maybe an ECG and pharm class and that’s pretty simple. So you have your ACLS card now and can interpret pretty basic cardiac rhythms. Does that mean EMT’s with ACLS should get to use monitors? Nope.
Although learning the bells and whistles of how a monitor works is pretty simple and you have knowledge of rhythms as a basic, there’s nothing in your scope of practice you can do if you spot an arrhythmia or other abnormal rhythms. Just like ETCO2, you can learn how to work with it and get good at it, but your scope doesn’t allow you to do s**t with it if the pt goes bad. So giving these things to basics is essentially a waste of money in the end.


Or a waste of resources. A patient in Afib is not necessarily a medical emergency. I saw basics with a monitor sit on scene for more than 45 minutes with a syncope patient that was in Afib, waiting for a medic to show up. (It was Skyway, for @FLMedic311)

Patient had vagaled down after a particularly strenuous BM. As the “private ambulance EMT” (or stretcher fetcher) I sat there, twiddled my thumbs and watched the volunteer fire EMTs, who should not have put the patient on the monitor to begin with, hem and haw over an ECG that they couldn’t discern.

No. You don’t get more toys.
 

E tank

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As someone with handy access to ETCO2 that mask ventilates people everyday, I have to say that I never, not ever, even look at the ET monitor. I feel the compliance of the bag, I watch the chest rise and fall, I fix any problems with mask seal and I see if an oral airway helps with either one.
 

DesertMedic66

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You know, many folks on the board have said that AEMT should be the baseline for 911 response. With all of the additions to EMT that I see in a lot of places (CPAP, IM epi, glucometry, SGAs), I'm almost getting to the point of saying that EMT response is sufficient for the bulk of emergency calls in urban & suburban areas...
The more stuff that is added makes me want to agree and I know a ton of EMTs who would do amazing in that setting however I would want to make the EMT program more than 120 hours and only 12 hours of field/clinical time (which is the bare minimum here).
 

EmergencyMedicalSike

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I gots' me an AED, I can fix two major problems right there.



Sure it does. I've got a BVM, some OPAs, some NPAs...it's the rare airway problem that I can't fix for a bit. And ETCO2 helps me to make sure I'm bagging correctly.

propermask-400x507.jpg
Well rhythms aside from v-fib and pulseless v-tach which are the only ones you’re supposed to shock. And I’m sure even EMT’s should know what v-fib and v-tach looks like
 

EmergencyMedicalSike

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Or a waste of resources. A patient in Afib is not necessarily a medical emergency. I saw basics with a monitor sit on scene for more than 45 minutes with a syncope patient that was in Afib, waiting for a medic to show up. (It was Skyway, for @FLMedic311)

Patient had vagaled down after a particularly strenuous BM. As the “private ambulance EMT” (or stretcher fetcher) I sat there, twiddled my thumbs and watched the volunteer fire EMTs, who should not have put the patient on the monitor to begin with, hem and haw over an ECG that they couldn’t discern.

No. You don’t get more toys.
Woah what? Basics with a monitor? Where is this magical county
 

DesertMedic66

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I would think that universal adoption of CPAP at the EMT level would prove to be much more beneficial than CO2 monitoring with regard to patient outcomes.

As far as the expanded formulary for EMT, it does seem much more fitting to merge the EMT/ AEMT training and education altogether.

@DesertMedic66 are they adding extended, and more in-depth curriculum to the EMT course where you teach?
CA state mandates about 120 hours and a single 12 hour field/clinical shift. My college is currently at about 180 hours of lecture and 48 hours of field/clinical shift. With the new courses we are having to add it is going to push us over 200 hours in lecture.

Our program director is involved pretty deeply in NREMT so we follow the national standards as a minimum. We would love to add lecture hours but have been getting some push back from the college. The college will not allow us to increase the field/clinical shifts due to insurance reasons.
 

FLMedic311

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Or a waste of resources. A patient in Afib is not necessarily a medical emergency. I saw basics with a monitor sit on scene for more than 45 minutes with a syncope patient that was in Afib, waiting for a medic to show up. (It was Skyway, for @FLMedic311)

Patient had vagaled down after a particularly strenuous BM. As the “private ambulance EMT” (or stretcher fetcher) I sat there, twiddled my thumbs and watched the volunteer fire EMTs, who should not have put the patient on the monitor to begin with, hem and haw over an ECG that they couldn’t discern.

No. You don’t get more toys.

To Skyways credit, I do have to say that a few months ago they correctly identified a 3rd degree HB on a otherwise asymptomatic Pt and requested us for eval. The initial complaint was weakness x3 days. But to your point I totally agree that often less is more. Also agree that ETCO2 in BLS is probably not beneficial
 

NomadicMedic

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South king County Washington. The fire EMTs had a LP12 to be used as an AED.
To Skyways credit, I do have to say that a few months ago they correctly identified a 3rd degree HB on a otherwise asymptomatic Pt and requested us for eval. The initial complaint was weakness x3 days. But to your point I totally agree that often less is more.

Was Mace the EMT? He went to medic school with me.
 

Gurby

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As someone with handy access to ETCO2 that mask ventilates people everyday, I have to say that I never, not ever, even look at the ET monitor. I feel the compliance of the bag, I watch the chest rise and fall, I fix any problems with mask seal and I see if an oral airway helps with either one.

That's the thing though - you do this every day. For us mere mortals who will probably BVM fewer people in a career than you do in a month, 1-person BVM technique is not so easy. I didn't realize how much I sucked at it until my OR time during paramedic school when I could look at the monitor and see what was going on.

On the other hand, rather than give emt-b's monitors and ETCO2 to help them with a skill they'll never ever get enough experience with to become proficient at, the better solution is probably to just push using 2-person BVM technique and King tubes.
 

FLMedic311

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Was Mace the EMT? He went to medic school with me.
To be quite frank I do not remember the names of the guys that were on the crew, they seemed jam up though, we had quite a few sick calls with them that day. I do wanna say I recall one of them having been to medic school.. that sounds familiar, but I could be making that up in my head..:rolleyes:
 

NomadicMedic

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I could be incorrect on this but I believe the primary reason for the BLS units with LPs is for the voice recording feature that we utilize for review of cardiac arrests

Yes. That’s what I was told too. Some of those audio recordings were great. Although, I know Physio was making simple AEDs with a voice recorder in them. I think consistency across all of the agencies was a big consideration when the ROC study was just getting underway.
 

VentMonkey

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Am I the only one who wonders if any of these shiny new, overzealous posters ever actually listen to the dialogue on here, and then go on to become quite the astute provider?...

I know if I had access to these sorts of forms, podcasts, and the general plethora of FOAM-ed when I was a noob I’d keep my Google-Fu, and YouTube University skills current as well.
 

Carlos Danger

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if the patient is wheezing, and the display shows a shark fin, give albuterol. if it doesn't, CPAP.

Exactly my point. It isn’t quite that simple in practice. A better approach is to go by history.
 

EmergencyMedicalSike

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I could be incorrect on this but I believe the primary reason for the BLS units with LPs is for the voice recording feature that we utilize for review of cardiac arrests
To be honest though I wouldn’t mind being assigned a LP to practice interpreting patient’s rhythms. But then again, wasteful resources
 

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