RocketMedic
Californian, Lost in Texas
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Lots of things, Clare. First, sidestream EtCO2 lets us determine objectively how compliant their lungs are and objectively measure that, on the move or in noisy environments, without needing to listen for lung sounds constantly. It doesn't remove the need to listen, but it does give me an objective assessment of their ventilatory efforts. It lets me identify air-trapping patients objectively and have a concrete, real-time EtCO2 valuation that i can associate with their metabolic carbonic acid level (just woke up, please bear with my less-than-stellar medical lingo). It lets me watch, real-time, how effective my treatments are, and whether or not the waveforms are responding- no more "all I hear is the nebulizer, Mr. Wheezer." It gives an objective RR monitor, and it can pick up v/q mismatches fairly well by studying the capnography numerics vs rate (tachypnic @ 50bpm with EtCO2 60 in COPD = air trapping, in nonspecific chest pain with no COPD = possible PE with one lung shut down perfusion-wise).
EMSA uses them on essentially everyone (all meds must be pushed with ECG, EtCO2 in place, a recent B/P where possible.) I think they are overused here, but I wouldn't want to give them up. They're far better than SpO2 sensors.
I actually used one this morning to differentiate between chronic COPD and an exacerbation and justify my decision to my patient. 81 y/o F, c/c fell from bed, AMAed from transport for the fall (no injuries), but I noticed her work of breathing and followed up on it. She said she was breathing normally, staff said it was normal-ish, I was suspicious. She was breathing pretty hard, wheezes in all fields with prolonged and quiet expiratory wheezing- but she's 81 with COPD, sats are on the low side of her normal, and she doesn't want to go to the hospital- how can I get her to recognize that she's having a COPD exacerbation with something other than my about-to-be-24 year old blue eyes and a 'trust me'? Capnography was tachypnic low-tidal-volume shark fins at 25, increasing to 65 with some improvement in tidal volume with administration of albuterol/atrovent (air trapping noted, this is partial relief). It objectively confirms my suspicions, and lets me 'see' my intervention's effectiveness. Plus it's great for patient education- she didn't want to go, but she needed to be seen (sick, and if I get a bad feeling about AMAing someone, I will educate them to the best of my ability and try and convince them to come along). Cue capnography class, taught over a nebulizer treatment (with some relief), complete with Lifepack printouts of the waveform and improvements from treatment. Ten minutes later, the woman who'd been intent on going back to bed and keeping her SpO2 at the lofty goal of 85%, who couldn't even stand up as she normally could, was totally ok with going to the hospital. Yes, it helped that she was an RN until 20 years ago, and that I am a pretty good improviser, and that I didn't go crazy trying to run roughshod over her with IVs and backboards and excitement. No, capnography didn't change my clinical impression, it reinforced it. No, it didn't govern my treatment, but it did allow me to assess its effectiveness even with minimal changes in lung sounds (it's great for differentiating chronic conditions from acute). It's also great for patient education.
Buy it, it's pretty cool (and a new-color line on your Lifepack, which you need to justify that empty space at the bottom of the screen).
