Modify ET CO2 tube adapter for nasal use.

[DocBrock]

I work for a private service that refuses to get nasal ETCO2. Anyone ever used a tube connection ETCO2 to get a nasal measurement ? I've been told it can be done with some modification.

 

[usalsfyre]

What's your plan for this? Using an unapproved, jury-rigged medical device to guide treatment isn't the best idea in the world. Most of the information gained from NC ETCO2 can be obtained using other assessments.

 

[DocBrock]

What's your plan for this? Using an unapproved, jury-rigged medical device to guide treatment isn't the best idea in the world. Most of the information gained from NC ETCO2 can be obtained using other assessments.

So you're telling me that you measure end title CO2 with other assessments? I'd be darn if you tell me that RR provides you with "most of the information gained from NC ETCO2" not sure what other assessments you're using.

 

[usalsfyre]

So you're telling me that you measure end title CO2 with other assessments? I'd be darn if you tell me that RR provides you with "most of the information gained from NC ETCO2" not sure what other assessments you're using.

Breath sounds, work of breathing, accessory muscle use, appearance of lethargy....you know old fashioned stuff that requires you put hands on the patient.

Considering you're not using the correct terminology for the diagnostic test in the first place, I don't think you really have any business trying to rig something up.

 

[TransportJockey]

I work for a private service that refuses to get nasal ETCO2. Anyone ever used a tube connection ETCO2 to get a nasal measurement ? I've been told it can be done with some modification.

I've messed with it with sidestream zoll adaptors. Its more trouble than its worth. On newer slipstream adaptors its more trouble than its worth

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[TransportJockey]

So you're telling me that you measure end title CO2 with other assessments? I'd be darn if you tell me that RR provides you with "most of the information gained from NC ETCO2" not sure what other assessments you're using.

I'd rather have end tidal than pulse ox. With the wave form i can tell if there's bronchoconstriction, paralysis wearing off, etc. And i can tell a whole lot more than just RR from just the numbers presented. It all comes down to a well educated clinician

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[usalsfyre]

I'd rather have end tidal than pulse ox. With the wave form i can tell if there's bronchoconstriction, paralysis wearing off, etc. And i can tell a whole lot more than just RR from just the numbers presented. It all comes down to a well educated clinician

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But you can't tell me anything about the quickest killer of your patient with ETCO2 Nate

 

[TransportJockey]

But you can't tell me anything about the quickest killer of your patient with ETCO2 Nate

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

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[VentMonkey]

Breath sounds, work of breathing, accessory muscle use, appearance of lethargy....you know old fashioned stuff that requires you put hands on the patient.

Considering you're not using the correct terminology for the diagnostic test in the first place, I don't think you really have any business trying to rig something up.

We have both options on using a NC, and in-line ETCO2 for (intubated) patients.

Op, I think his post is spot on. Try not to get too caught up in diagnostic tools, which is what this essentially is, over good old fashioned assessment skills. Use your hands on skills, instinct, clinical judgment, and trust your gut before relying so heavily on a number presented on a screen. They can often be unreliable and/ or altered for a number of reasons.

Plus, I can almost guarantee, most ER physicians will not base their treatments, or yours for that matter, to be rendered based on a value that will be easily discarded and reassessed for something more accurate as say, a stat ABG.

 

[DocBrock]

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

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End title should be a standard on any patient who receives oxygen or complains of respiratory complications. Not using this amazing tool is as bad as not performing a 12 lead on a chest pain. Simply not using technology is a choice. A terrible lazy one.

 

[usalsfyre]

We have both options on using a NC, and in-line ETCO2 for (intubated) patients.

Op, I think his post is spot on. Try not to get too caught up in diagnostic tools, which is what this essentially is, over good old fashioned assessment skills. Use your hands on skills, instinct, clinical judgment, and trust your gut before relying so heavily on a number presented on a screen. They can often be unreliable and/ or altered for a number of reasons.

Plus, I can almost guarantee, most ER physicians will not base their treatments, or yours for that matter, to be rendered based on a value that will be easily discarded and reassessed for something more accurate as say, a stat ABG.

A lot of EMS providers like ETCO2 because it gives a nice, neat number that doesn't appear to give false positives nearly as much as SpO2. However many times they don't really understand what they're looking at and how different is actually is from PaCO2, and that hypercapneia almost never kills you.

 

[usalsfyre]

End title should be a standard on any patient who receives oxygen or complains of respiratory complications. Not using this amazing tool is as bad as not performing a 12 lead on a chest pain. Simply not using technology is a choice. A terrible lazy one.

Yeah...no. You don't have a farking clue what you're talking about. If that's the case then why isn't every little old lady in a SNF wearing ETCO2? Or even every patient in an ICU? Get your head out of Backboard Action Monthly and into a physician level text if you want to learn medicine.

 

[usalsfyre]

By the way it's end TIDAL carbon dioxide. You know...like TIDAL volume. Perhaps learn the name of the tool before you lecture on its use.

 

[VentMonkey]

A lot of EMS providers like ETCO2 because it gives a nice, neat number that doesn't appear to give false nearly as much as SpO2. However many times they don't really understand what they're looking at and how different is actually is from PaCO2, and that hypercapneia almost never kills you.

Key word being provider; my word is clinician.

 

[DocBrock]

Yeah...no. You don't have a farking clue what you're talking about. If that's the case then why isn't every little old lady in a SNF wearing ETCO2? Or even every patient in an ICU? Get your head out of Backboard Action Monthly and into a physician level text if you want to learn medicine.

Isn't this an EMS website?

 

[usalsfyre]

Isn't this an EMS website?

Yes, and medicine is the real job of EMS providers. Not public safety, not firefighting...delivering medicine in out-of-hospital, transport and austere environments.

 

[VentMonkey]

Yes it is. Just try and stay open minded.

usalsfyre is simply pointing out that not all patients require this tool, nor does everyone require a 12-lead ECG.

Again, it's simply meant as a different point of view. Try looking up PACO2 vs ETCO2, that may help as well. Things are never cut and dry in this industry so try not to get too offended, otherwise you'll be in for a very long (or short), and miserable EMS career.

Either way, don't take it too personal, and feel free to keep asking questions. A lot people on this forum are remarkably knowledgeable.

 

[DocBrock]

Yes, and medicine is the real job of EMS providers. Not public safety, not firefighting...delivering medicine in out-of-hospital, transport and austere environments.

I just find it interesting that you immediately start replying in a aggressive tone. If you wish to edjucate why not do it in a positive attitude and maybe things wouldn't end up in a negative tone. Just a thought bro.

 

[DocBrock]

Yes it is. Just try and stay open minded.

usalsfyre is simply pointing out that not all patients require this tool, nor does everyone require a 12-lead ECG.

Again, it's simply meant as a different point of view. Try looking up PACO2 vs ETCO2, that may help as well. Things are never cut and dry in this industry so try not to get too offended, otherwise you'll be in for a very long (or short), and miserable EMS career.

Either way, don't take it too personal, and feel free to keep asking questions. A lot people on this forum are remarkably knowledgeable.

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

 

[usalsfyre]

Ok, I'll admit I'm grumpy and I apologize for that.

That said, there's a number of ways to obtain the info you're looking for. Maybe not with a neat little clean number (that really means very little without a baseline ABG, but that's another story), but honestly good assessment skills won't fail you when ETCO2 will. Not "treat the patient not the monitor (God, I hate that saying), but learning how to look at the patient, all available information and make a good decision regarding treatment. ETCO2 is WONDERFUL for monitoring tube placement, I won't intubate without it. However I've found NC capnography makes very little difference in my treatment decisions. It makes it a little easier to monitor a sedated patient, a little more sure on seeing bronchospasm, but it hasn't made any fundamental changes in how I approach assessment and treatment, and I've yet to see an ETCO2 reading I didn't already suspect from an initial assessment. No other branch of medicine outside of some EDs have adopted NC ECTO2, and even then they generally only use it as an adjunct to procedural sedation.

So it's not totally a gimmick, but it doesn't make a fundamental change in treatment. A 12 lead drives destination and downstream care. Can you say that about ETCO2?