MasterIntubator
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Ehh ehh... forgot about the OD... I wonder if the hydrocarbons can change the pH in a way that would give those results... definitely interesting!!!
ETCO2 of 9
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sdadam
DialedMedics.com
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Ummmm...
A low ETCO2 reading is expected for a metabolic acidosis patient.
The active ingredient in break fluid is ethylene glycol, when ingested it is metabolized by alcohol dehydrogenase in to (mainly) glycolic acid and oxalic acid.
This increase in acid production results in a decrease in bicarb, without bicarb protons are not converted to CO2 to breath off.
This patient is in anion-gap metabolic acidosis and the low ETCO2 is expected.
A low ETCO2 reading is expected for a metabolic acidosis patient.
The active ingredient in break fluid is ethylene glycol, when ingested it is metabolized by alcohol dehydrogenase in to (mainly) glycolic acid and oxalic acid.
This increase in acid production results in a decrease in bicarb, without bicarb protons are not converted to CO2 to breath off.
This patient is in anion-gap metabolic acidosis and the low ETCO2 is expected.
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Not quite right. In metabolic acidosis, Le Chatelier's principle shows CO2 levels will increase to balance out the increased H+ ions. With an intact respiratory compensatory mechanism, they will hyperventilate to blow off excess CO2. See DKA for an example. This may lower the EtCO2 some from its elevated acidotic levels, so you'll see a balance between both.
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You seem to be confusing pH with Etco2
More hydrogen ions (lower pH) = more Co2 in blood = more Co2 in expired gas (increased Etco2)
The common thread I hear from this is hyperventilation. But as brought up previously the low EtCO2 can very well be not a reliable indicator of the PaO2 (the amount of oxygen in serum plasma). As brought up previously by 46young and halothane for an appropriate correlation between EtCO2 and PaCO2 you have to have all the following factors being functioning normally: enough CO2 production and diffusion to circulation; enough cardiac output to get the CO2 from the cells to the lungs; the ability for CO2 to diffuse into the aveoli from the bloodstream; and enough minute volume to get the CO2 out of the airway. If there is a breakdown in any of the above 4 processes then the EtCO2 will not equal the PaCO2. The prime example of this that we are all taught is the low EtCO2 in a patient with a PE, but many of us seem to just focus on either PE or hyperventilation as the end all causes for a low EtCO2.
Capnography has it's uses, and I think it's the biggest advancement in our practice of medicine in quite a while, but remember that it by itself has it's limitations. We can treat hypercapnia by EtCO2 only but we can not treat hypocapnea by EtCO2 alone. If you are assuring proper minute ventilations for your patient and the EtCO2 is still low than it is probably not an issue that ventilation changes are going to help.
The only way to be able to see if the EtCO2 matches appropriately with the EtCO2 is to draw an ABG on the pt so you can measure the PaO2 directly. Without that even though your EtCO2 is low the actual PaO2 could be low, normal, or high. Remember that they drank a very caustic liquid that can cause many violent changes to the body, not to mention the risk of aspirating it. The end of the day be sure to ensure proper minute ventilations and treat your patient like always and never just the machine.
Capnography has it's uses, and I think it's the biggest advancement in our practice of medicine in quite a while, but remember that it by itself has it's limitations. We can treat hypercapnia by EtCO2 only but we can not treat hypocapnea by EtCO2 alone. If you are assuring proper minute ventilations for your patient and the EtCO2 is still low than it is probably not an issue that ventilation changes are going to help.
The only way to be able to see if the EtCO2 matches appropriately with the EtCO2 is to draw an ABG on the pt so you can measure the PaO2 directly. Without that even though your EtCO2 is low the actual PaO2 could be low, normal, or high. Remember that they drank a very caustic liquid that can cause many violent changes to the body, not to mention the risk of aspirating it. The end of the day be sure to ensure proper minute ventilations and treat your patient like always and never just the machine.
MySandie
Forum Ride Along
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IMO, that type of cannula should be used more often in hospitals
The picture of the cannula that redirects oral breaths back into the body is awesome. I wish they were used in hospitals, because it would help with dx.
The picture of the cannula that redirects oral breaths back into the body is awesome. I wish they were used in hospitals, because it would help with dx.
There's a few take home points here:
* End-tidal CO2 is a product of cardiac output and PaCO2. It doesn't always directly correlate to PaCO2, but generally the PaCO2 is not less than the PETCO2.
* This patient likely has a partially compensated anion gap metabolic acidosis from the toxic alcohol. With respiratory compensation the PaCO2 and ETCO2 will decrease.
* End-tidal CO2 is a product of cardiac output and PaCO2. It doesn't always directly correlate to PaCO2, but generally the PaCO2 is not less than the PETCO2.
* This patient likely has a partially compensated anion gap metabolic acidosis from the toxic alcohol. With respiratory compensation the PaCO2 and ETCO2 will decrease.
Hi! EMT and Paramedic student here.
I've had a EtCO2 of 9 and I was still completely coherent!
I get panic attacks semi-regularly and after experiencing one in school and having my professors hook me up to the monitor and teach me what was happening while I was deep in it - I was fascinated by my experiences. This didn't stop them however, and it sort of made them worst because I knew what was happening and I knew what would help, but my "lack of control" made me more afraid.
My experience was this: I was full-time paramedic student (and EMT) working at a haunted house (as an actor), I had a panic attack and went and sat with the medics. They put the pulse ox and nasal cannula l on and I watched my EtCO2 decline rapidly. I had only had this experience once, when my professors were instructing me. Since then I had many experiences with carpal pedal spasms and oh MAN they're weird.
Basically, my sats were 94% and my end tidal read 9. The medics could not believe it because I was sitting up and obviously still awake. One thing that happens with my panic attacks is that I tend to hold my breath and breathe out fast and hard, not really fast and shallow.
They didn't have O2 with them (lol), but I eventually got better on my own. I haven't met another medic who has experienced a panic attack, and I'm saddened by the number of medics who don't take these seriously. -glad to see this isn't happening in this thread-
tl;dr I had an ETCO2 of 9 and was upright and conscious.
I've had a EtCO2 of 9 and I was still completely coherent!
I get panic attacks semi-regularly and after experiencing one in school and having my professors hook me up to the monitor and teach me what was happening while I was deep in it - I was fascinated by my experiences. This didn't stop them however, and it sort of made them worst because I knew what was happening and I knew what would help, but my "lack of control" made me more afraid.
My experience was this: I was full-time paramedic student (and EMT) working at a haunted house (as an actor), I had a panic attack and went and sat with the medics. They put the pulse ox and nasal cannula l on and I watched my EtCO2 decline rapidly. I had only had this experience once, when my professors were instructing me. Since then I had many experiences with carpal pedal spasms and oh MAN they're weird.
Basically, my sats were 94% and my end tidal read 9. The medics could not believe it because I was sitting up and obviously still awake. One thing that happens with my panic attacks is that I tend to hold my breath and breathe out fast and hard, not really fast and shallow.
They didn't have O2 with them (lol), but I eventually got better on my own. I haven't met another medic who has experienced a panic attack, and I'm saddened by the number of medics who don't take these seriously. -glad to see this isn't happening in this thread-
tl;dr I had an ETCO2 of 9 and was upright and conscious.
1. Holy Necropost
2. Of course your ETCO2 was low in a panic attack, you were hyperventilating, so your sats would stay high and ETCO2 would be down. This is not surprising at all., putting anxiety pts on o2 is useless in a hypervent situation. Breath coaching is by far the most effective tool in my experience.
2. Of course your ETCO2 was low in a panic attack, you were hyperventilating, so your sats would stay high and ETCO2 would be down. This is not surprising at all., putting anxiety pts on o2 is useless in a hypervent situation. Breath coaching is by far the most effective tool in my experience.
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Why would you need oxygen with an SpO2 of 94 and what would oxygen do to help it?
Someone hyperventilating at a rate of 70 or 80 is going to have a low, possibly less than 10 EtCO2. Not sure what's unusual about that. I used to put EtCO2 cannulas on hyperventilating patients in an effort to have them watch themselves improve with breathing exercises, but that's a bit expensive for a refusal and of debatable utilities.
It's a bit shameful how few EMS providers really learn to manage stress and anxiety, to include when and when not to use medication.
E tank
Caution: Paralyzing Agent
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They were freaking out a bit about their lack of supplies and one of the medics hadn't even seen a panic attack before. When I started getting the carpal pedal spasms I was trying to explain to him how they felt and think he was stressed because he couldn't do anything for me, even though I told him I just had to chill tf out. I've never needed O2 because yeah it's not going to do anything.
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Ran an anxiety attack the other day, the driver/engineer asked if he should go retrieve a paper bag with zero irony.
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That ability to compensate is often the only thing that gives EMS a chance to save them.
In training when we got Capnography I was able to get my RR up to 80-90 with it and SP02 on and keep it there for about 15 minutes. readings were 96-99%, and 25-30. Drove the 2 medics teaching the class crazy, because "It shouldn't be happening". Just like it shouldn't happen that I walk around with a room air of 88% and bp 80/40. Some people and patients are strange and don't fit the 'normal ranges'
Have you put had an echo?
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I was wondering the same thing.