Modify ET CO2 tube adapter for nasal use.

[VentMonkey]

Thank you, I really respect the way you answer questions. I look forward to reading more from you.

Thanks. Again, I must reiterate what usalsfyre said was spot on. It may not have been in a manner that suited your liking, but if I "had a nickel for everytime..." a doctor, nurse, preceptor or what have you scolded me either callously, or otherwise, forcing me to research my facts, I would be retired by now.

Don't be afraid to do a little homework on your own as well, and also medicine is ever changing. Many of us on this site view what we do as just that, medicine. A chain in the link of a continuum of care, and for that we owe each and every patient the best we can give them be it constant research, con-ed, or insight from the "elders" in this field.

 

[usalsfyre]

Lol true. But an uneducated paramedic is pretty high up there on quickest killers. Or Reeves County Hospital, either or

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Those both clock in pretty damn high on the list....

 

[zzyzx]

DocBrok, I think you've been oversold on ETCO2.
For tube confirmation and monitoring, it is crucial. But beyond that, it is of limited benefit.
In those situations were you really do need to know the PaCO2, you need an ABG. You cannot count on the ETCO2 to match the PaCO2 in many patients. In addition, in situations were you want to know an accurate PaCO2, you would want to know the pH and bicarb as well, which only an ABG will tell you.

 

[NomadicMedic]

I don't think oversold is the right answer... but IMHO, ETCO2 is certainly more valuable than just as a method of tube confirmation.
Simply using it to help guide treatment in CHF vs COPD in comorbid patients is worth it. Using it to assess impaired gas exchange is valuable.
Using it to assess for inspiratory effort in a RSI patient that may require additional paralytics is valuable. Don't you agree?

And a stat ABG isn't available in most EMS trucks here. (Neither is POCUS, stat troponin or cinnamon flavored oxygen...) So, shouldn't we use the tools that we have and our skills as clinicians to interpret the data to make the best choices for our patients?

 

[VentMonkey]

I don't think oversold is the right answer... but IMHO, ETCO2 is certainly more valuable than just as a method of tube confirmation.
Simply using it to help guide treatment in CHF vs COPD in cormorbid patients is worth it. Using it to assess impaired gas exchange is valuable.
Using it to assess for inspiratory effort in a RSI patient that may require additional paralytics is valuable. Don't you agree?

And a stat ABG isn't available in most EMS trucks here. (Neither is POCUS, stat troponin or cinnamon flavored oxygen...) So, shouldn't we use the tools that we have and our skills as clinicians to interpret the data to make the best choices for our patients?

I absolutely agree with you, and have used it in lieu of other tools available to me as you've mentioned.

Perhaps the take away with this thread is for anyone to get too caught up in it's prehospital use because it doesn't provide a definitive answer to an ongoing problem. Then again, neither do we as prehospital clinicians.