Called for a seizure. We found a postictal 80 year old man. No prior historyof seizure, who they said fell the night before, but hadn't appeared injured. Out in the ambulance he started seizing again. I managed to get a 24 gauge in his arm just as he stopped seizing. I had the ETC02 on and was watching his respirations now. He didn't look like he was breathing. It was more sort of burping.
I'm not certain what the little bumps represented -- the burps possibly, but I believe now I just had the cannula too deep in his nose and not enough over his mouth. I repositioned it, as he started taking deeper breaths. His end tidal was 80.
His breathing was very irregular, sporadic.
I kept waiting for him to snap out of it, but he wasn't coming around. I tried bagging him for a little bit, and then decided just to intubate him. I attached the capnography filter to the top of the ET tube, put in the stylet and went in. Saw the chords, saw good wave form on the monitor and I was good. I bagged him and got his ETCO2 down to 35.
He started bucking the tube a little so I gave him some versed.
At the hospital they said he had been in the hospital for a subdural hematoma a month before, so he may have been bleeding again.
Here's the trend summary for ETCO2 and RR:
Note: The apnea period includes a period where his nasal monitor is off and the ET tube isn't in yet. I have to unplug one filter, plug in the other and then I won't start getting a reading until I go in with the tube.
What lesson did I learn from the capnograpy? It alerted me that he was hypoventilating and his respiratory pattern was sporadic and ineffective. I was much more aggresive with the airway than I might have been based just on naked eye observations.