Capnography for EMT-B, a useful tool?

Remi said:
What the heck are you talking about? Providing a counter-example equates to a straw man now?
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I gave a realistic scenario. you didn't answer it. I'm not sure what is so unclear, other than you decided to use a strawman response to a valid question. So either you are unable to actually read my scenario, or unwilling to actually think outside of your small little box. in either way, I'm not going to waste any more time with you.
Remi said:
As usual, you are more focused on looking for ways to "win" the discussion than on understanding the other person's point. I think you just have no idea what I'm talking about, so you attack it.
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it's not about winning, it's about being able to make a decent position based on the facts at hand, something you seem to not like. You seem to lack the critical thinking ability to do it.
Remi said:
Again, you completely missed the point. The relevance of an example that someone provides is not contingent on the fact that your agency has so little faith in your judgement. If you can't figure out how my example of the asthmatic relates to the topic at hand, then I don't know what to tell you.
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it's a great example.... it's also completely irrelevant. Yes, in one specific example, it applies. but you can't arbitrarily treat people solely based on history. Maybe you can in your current role, but most in EMS can't treat based on the patient's history, when the patient's condition doesn't warrant it. Not about faith in judgement.....

if you can't understand that, than I really wonder who you ever advanced above the EMR level. And quite honestly, I'm done responding to you on this topic. Not worth wasting the keystrokes or the time.
 
DrParasite said:
in many other resp arrest calls, wouldn't you be ok with them dropping a king?

It really depends on several factors.

In short, if I am there simultaneously with the fire department, the reversible causes have been ruled out, they’re effectively ventilating this patient with BVM for the time being, and the predictability of the airway seems uncomplicated I’d prefer ETI placement with a properly sized ETT so that hospital doesn’t have to include this step in their treatment.

I’d also hope my colleagues would think the same, and would take into account the reason for proper tube size with regard to ventilator dependency. Saying it’s a new toy and down playing it makes me cringe just a tad.
At least this firefighter was being proactive about doing something involving patient care, or simply standing back and doing the circle of death until EMS arrived and told them what to do. Overeager firefighter (and offers to help) vs firefighter who doesn't want to touch the patient..... hmm which is better....

Honestly, neither. I get your point, and it is valid. I think we’ve both seen each example that you’ve listed, but not having to worry about either would be phenomenal.

Now, to add to this. The firefighter was in fact very helpful and receptive, but what if I hadn’t caught it and the patient would have aspirated once the Narcan kicked in all because they wanted to play with a new toy?
you can't cure stupidity, some people will never grasp the concept of critical thinking skills, and unfortunately, medic mills are pumping out new medics because there is money to be made in paramedic education, and they don't want to fail people because it looks bad for the program.

Absolutely agree and have no rebuttal here.
If an objective tool will help someone with their assessment, or possibly detect an issue they wouldn't otherwise see, what's the harm? More accurately, what negative patient outcomes do you predict happening if we give BLS another assessment tool?

To answer both of these questions at once, and as demonstrated above, the harm would be at minimum, over treatment of said patient; at worst, clearly, a sentinel event.
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Now, to add to this. The firefighter was in fact very helpful and receptive, but what if I hadn’t caught it and the patient would have aspirated once the Narcan kicked in all because they wanted to play with a new toy?[/quote]I was actually going to bring that up, how we all have heard stories about OD patient's being intubated, narcan being given, and then they pull the tube out.

I guess the question I would ask is would you be giving the narcan or the FF? If you are, I would imagine you would direct the firefighter to remove the airway prior to given narcan. if they are, well, I see your point.

ETI vs SGA....more and more places are going to SGA instead of ETI..... and weren't you one of the people who said we shouldn't do something just to make the hospital's job easier? And I'm not saying the FD wants to drop the king simply because it is a new toy, but if it was being recently trained as the new device, and his training said if they aren't breathing, drop the king, I can see why he wanted to, especially if they haven't had the chance to in the past. But that's a different topic, and I will agree there should be a time when providers should and should not drop a SGA (and an opiod OD is one where I would avoid it.).
 
DrParasite said:
ETI vs SGA....more and more places are going to SGA instead of ETI..... and weren't you one of the people who said we shouldn't do something just to make the hospital's job easier? And I'm not saying the FD wants to drop the king simply because it is a new toy, but if it was being recently trained as the new device, and his training said if they aren't breathing, drop the king, I can see why he wanted to, especially if they haven't had the chance to in the past. But that's a different topic, and I will agree there should be a time when providers should and should not drop a SGA (and an opiod OD is one where I would avoid it.).
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Lol, clearly I say a lot of things. However, let me add this critical-thinking wrinkle-

Yes, SGA’s are certainly becoming commonplace in such circumstances like cardiac arrests, be it traumatically or medically-induced, but the respiratory arrested patient also has a pulse.

They have yet to surpass that threshold and are the unique demographic that would benefit from early ETI when done properly by the most-skilled provider at the scene of their emergency.

Put another way, the patient with no obvious protective airway reflexes left, but phenomenal vital signs otherwise doesn’t need to be re-intubated in the ED further disrupting their airways if, and when, it can be done early with confidence and proficiency.

If we’re blindly placing SGA’s on patient’s who’s airway should have been managed more invasively, and we have the ability to do so in the first place, is this better or worse?

And as far as doing things for the hospitals. My words of the day at work are along the lines of: “as seamlessly proficient, and efficient as possible.”
 
DrParasite said:
if you can't understand that, than I really wonder who you ever advanced above the EMR level.
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Lol, that’s pretty funny coming from a guy who is barely above the EMR level himself and so frequently uses terms like “straw man” when he clearly doesn’t even know what they mean.

Again, the relevance of an example is not affected in any way by your lack of ability to comprehend it. Just because you don’t get something doesn’t make it a logical fallacy.

Every discussion with you comes down to you attacking comments and arguments that you don’t understand. You are the only one on this forum that does this so consistently. I wonder why that is.
 
Capnography could be great as you said if you know how to read it but it can definitely help with unconscious pt's, OD's, and almost anyone with respiratory distress.
 
EMTlash said:
Capnography could be great as you said if you know how to read it but it can definitely help with unconscious pt's, OD's, and almost anyone with respiratory distress.
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Why? How would capnography make any impact on your treatment?
 
NomadicMedic said:
Why? How would capnography make any impact on your treatment?
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Pretty nice to be able to see someone’s breathing and ETCO2 in real time. Say you’re mask ventilating an OD patient or cardiac arrest and doing a crappy job - waveform capnography will let you know in no uncertain terms. Say you’re bagging and getting a good seal, but either going too fast or too slow - capnography will let you know.

That probably should have been an ALS call anyways though, and those rare instances probably don’t justify the cost of putting a monitor on a BLS truck, and the average EMT-B probably isn’t going to make effective use of capnography in the rare instance when it could be helpful... But theoretically it could impact treatment in some cases.
 
Gurby said:
Pretty nice to be able to see someone’s breathing and ETCO2 in real time. Say you’re mask ventilating an OD patient or cardiac arrest and doing a crappy job - waveform capnography will let you know in no uncertain terms. Say you’re bagging and getting a good seal, but either going too fast or too slow - capnography will let you know.

That probably should have been an ALS call anyways though, and those rare instances probably don’t justify the cost of putting a monitor on a BLS truck, and the average EMT-B probably isn’t going to make effective use of capnography in the rare instance when it could be helpful... But theoretically it could impact treatment in some cases.
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Me thinks Kemosabe was looking to get the green horn's wheels turning:)...
 
It's not needed on every call, but I think anytime you're placing a patient on the monitor, then yeah get a capnography reading. I wished our department let us use capnography more, we're only required to do so on cardiac arrests, but it's a much better and more useful tool than pulse ox and it can help determine what treatment is needed for respiratory patients as well as determine a patient's metabolic status. But yes, it should be a basic skill, it's practically a vital sign.
 
VinceVega91 said:
I wished our department let us use capnography more, we're only required to do so on cardiac arrests, but it's a much better and more useful tool than pulse ox and it can help determine what treatment is needed for respiratory patients as well as determine a patient's metabolic status. But yes, it should be a basic skill, it's practically a vital sign.
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Wait... you're a paramedic right? I just wanted to make sure I read that right

So you are only REQUIRED to use capnography on cardiac arrest patients, but you WISH your department would let you use capnography more? Do they prohibit you from using it on other non-cardiac arrest calls? Has your supervisor / medical director pulled you aside and said "Hey vince, your going to have to stop using this medical device, that we provide to you, on all non-cardiac arrest patients?"

What's stopping you from using it on every cardiac and respiratory related patient?
 
DrParasite said:
Wait... you're a paramedic right? I just wanted to make sure I read that right

So you are only REQUIRED to use capnography on cardiac arrest patients, but you WISH your department would let you use capnography more? Do they prohibit you from using it on other non-cardiac arrest calls? Has your supervisor / medical director pulled you aside and said "Hey vince, your going to have to stop using this medical device, that we provide to you, on all non-cardiac arrest patients?"

What's stopping you from using it on every cardiac and respiratory related patient?
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Our rules and procedures are at times questionable and sometimes silly. Unfortunately we do not carry the nasal cannula capnography on our trucks, we only carry the ET tube ones. And yes they actually do prohibit us from using capnography on non-cardiac arrest calls, people have been disciplined for it even though their is scientific research that proves the benefits of it. Trust me,I don't agree with it. Our medical Director is trying to get our division to be more on board and embrace the usefulness of capnography, but it is such an exotic tool, that it is taking our division forever to do so.
 
VinceVega91 said:
It's not needed on every call, but I think anytime you're placing a patient on the monitor, then yeah get a capnography reading.
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That is really not cost effective nor beneficial. If I used capno on all those patients then I would be going through 4-10 a day for no purpose. If I’m recording a 12 lead on someone with chest pain to look for a STEMI then an EtCO2 isn’t going to be very beneficial.

I think the only time I use capno on patients where it not really needed is on my LDTs only so that I can transmit data from the monitor and it will automatically put in BP, HR, SpO2, and RR. That’s just because I’m lazy and putting in 15 sets of vitals gets rather boring.
 
I use it on every difficulty breathing call.
 
E tank said:
Short ETT placement or mask ventilation, where would your decision making change as opposed to without it?
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I don't use it to make decisions. I treat my patients, not the monitor. I use it as a diagnostic tool to see how much respiratory distress the patient may or may no be in, or is it even respiratory or metabolic?
 
CALEMT said:
I don't use it to make decisions. I treat my patients, not the monitor. I use it as a diagnostic tool to see how much respiratory distress the patient may or may no be in, or is it even respiratory or metabolic?
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???
 
Remi said:
???
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Lol I get the confusion with that contradiction. I probably should have worded it a little differently than I did.
 
CALEMT said:
Lol I get the confusion with that contradiction. I probably should have worded it a little differently than I did.
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I get what you meant: even though it isn't necessarily going to change your treatment plan (you probably aren't going to give a neb to a 25 year old with no history of asthma who isn't wheezing, just because you see something resembling a shark-fin on the capno), it's more information that helps you form a more complete clinical picture.

I think the greater point is that if an assessment tool isn't going to change our treatment, why do we do it? Even if we feel like the info helps us formulate a more accurate diagnosis, what value does it really bring, if we are just going to do the same thing for the patient with or without the information?
 
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