July Capnography Log
July 28, 2006 - Hyperventilation
Had a 22 year old under stress at work and home complaining of dsypnea, cold and numb extremities. Unable to move fingers. Put him on the capnography.
Respiratory rate of 40, ETCO2 of 26.
After coaching him to slow his breathing, hir respiratory rate went down to 10 and his ETCO2 went up to 40. The cold numb feeling went away and he was able to move his fingers again.
July 25, 2006 -Capnography in Cardiac Arrest
See Case Study Five -- I've been waiting for a code with return of spontaneous circulation just to get the trend summary, and I finally got it. It was a great strip. Unfortunately, although we got the patient back three times, he didn't make it.
Dsypnea - COPD/MI with dsypnea, very slight expiratory wheeze, but she was breathing shallow and fast, with pursed lips, often breathing out before she had finished breathing in. Note the shape. One breathing treatment helped a lot.
July 19, 2006 - Capnography During Sedation and monitoring for Apnea
Capnography to Monitor for Apnea:
We intercepted with a basic unit for a possible cardiac arrest. It turned out to be a patient with end-stage cancer who was a DNR, but the family didn't have the paperwork. She had become unresponsive and they thought she had stopped breathing.
When I climbed in their ambulance I saw her she was breathing, but responsive only to pain. The crew said her BP was 80/50. I put her on the monitor to see a sinus rythmn and put her on capnography.
While I was going for an IV line, the apnea alarm went off.
I gave a sternal rub and she started breathing again.
Here's a strip of her declining respirations:
She had several episodes of apnea, but now by watching her we were able to keep her aroused enough to get her to the hospital without having to do any advanced airways or to bag her. There they were able to contact her doctor and affirm she was a DNR.
Here's the trend summary:
Capnography to monitor pain sedation meds:
As I mentioned earlier when I was in Ohio I met a medic from Texas whose service used capnography quite regularly and who had a protocol requiring capnography on all patients who recieve pain meds or sedation meds.
This patient was an 80 year old woman with kidney stones who got Morphine for pain relief:
Here's the pre-MS capnography:
Here's the post MS capnography:
The respirations widen out a little as she relaxes.
And the Trend summary:
Nothing spectacular, but a good practice to get into for all patient's who should be monitored for respiratory depression following medication administration.
July 11-12, 2006 National Registry Committee Meeting
I just attended a committee meeting at the National Registry. They selected nine field medics from across the country with various experiences and from various types of services to spend two days with a facilitator from Ohio State to do a duty/task analysis of what paramedics do to help develop a curriculm and tests based on the real world. I naturally pushed capnography as a needed technology. It was interesting talking to the other 8 field medics from all parts of the country. Some had been using capnography regularly -- one had even participated in field research, others still weren't using it. One guy showed me his pain protocol which required capnography on every patient requiring sedation. I also met an EMS Educator from Texas involved with the Biotel system. One of my first links at this blog was to the wave form page of their protocols.
July 8, 2006 - Back from Vacation
Back from vacation, but had no patients requiring capnography today, which is okay I guess because we are getting low on cannulas while awaiting our order. The night medic here is also excited about capnography and so I have competition for our limited supply of cannulas. Fortunately more should be on the way.
I spent part of the day, answering some email questions from a reporter doing a story on the non-hospital use of capnography for a trade magazine for respiratory care specialists. One of her questions was about the interface with the ER staff, and its possible my answer may surprise her. The answer being that most people in the ER have no idea what we are talking about when we come in spouting about wave forms and capnometers. The night medic has remarked on the same problem to me. It's going to be interesting to see how this progresses. Of our two major hospitals, one has capnography only for intubations and the other is getting equipment -- again only for intubated patients. The key will probably come only when more research comes out showing capnography's utility in the non-intubated patient. One of my goals this month will be to compile a list of research projects I would like to see involving capnography.