Comments on Capnography for Paramedics: 10 Things Every Paramedic Should Know About Capnog...

Thank you very much for that resource. As an Advan...

2007-10-16T20:11:00.000-07:00

Thank you very much for that resource. As an Advanced Care Paramedic student, I found your information invaluable.
I will carry forward your wisdom into my practice!

Thanks, I will change it when I find it.PC

2007-08-14T03:02:00.000-07:00

Thanks, I will change it when I find it.

PC

Wonderful,informative article--the kind I've come ...

2007-08-05T22:18:00.000-07:00

Wonderful,informative article--the kind I've come to expect from you.But please note that there is no such word as "irregardless".Just use "regardless"...

Mr. Canning,Prior to becoming a paramedic, I read ...

2007-05-07T20:26:00.000-07:00

Mr. Canning,

Prior to becoming a paramedic, I read both of your non-fiction paramedic books. Your stories played a very significant role in inspiring me to not only become a paramedic, but to strive to become a great paramedic. Thank you for your writing and for this very informative capnography paper. You do excellent work.

Chad Ledson
Portland, OR

Interesting comment. Thank you. I have added an ...

2007-02-19T10:08:00.000-08:00

Interesting comment. Thank you. I have added an asterisk in the document:

* True as a general rule, but may not hold for cases of greatly prolonged down time prior to initiation of CPR or cases of massive pulmonary embolism where blood flow to the lungs is completely blocked. Also, in patients in arrest, CPR is neccessary to generate a waveform.

I am going to ask other medics about their experiences. I have intubated some fairly dead people and had low, but detectable ETCO2 readings with small wave forms that degenerated into even lower readings and smaller wave forms, but never had anything lower than a 3. I did have a medic report a reading of zero. I will have to ask him the state of the patient as far as down time. Any idea of when the blood in the lungs would coagulate suffiently enough to give a zero reading as opposed to the time neccessary to show the first signs of rigor and/or lividity, which would preempt resuscitation according to our protocols?

The PE exception I gave is theoretical.

Thanks again for your comment. I appreciate any help in making the document better or increasing my understanding of capnography.

This is such a new area that I think field medics are going to observe things before studies are done to confirm them.

PC

In reference to the statement, "Reasons ETCO2 is z...

2007-02-19T08:29:00.000-08:00

In reference to the statement, "Reasons ETCO2 is zero: The tube is in the esophagus", there is an additional reason for a "zero" reading.
If cardiac arrest is experienced for a prolonged time frame, the blood will begin to coagulate. As far as EtCO@ monitoring is concerned, the pulomary vasculature is of primary importance. If pulmonary blood volume is coagulated, there will be little gas exchange occuring within the pulmonary capillary vasculature, potentially showing a reading of 0 mmHg EtCO2, also potentially providing no wave forms. This could indicate a possible inaccurate value to the healthcare provider, indicating esophgeal tube placement, when the ET tube has been successfully placed. This is important in the prehospital enviornment, especially if protocols allow for termination of CPR efforts, with substantially low EtCO2 values. It may promt the healthcare provider to extubate a successfully intubated patient, based on false information provided by capnography.
Although a "flatline" wave form does indicate 0 mmHg of EtCO2, it is not a reliable value for confirming ET tube placement in the catagory of unwitnessed prolonged cardiac arrest.

great,real good,thank you

2007-01-30T09:09:00.000-08:00

great,real good,thank you

Very nice and complete overview of this tool. Next...

2007-01-15T04:11:00.000-08:00

Very nice and complete overview of this tool. Next you should describe how to implement the device for asthma and other non arrest patients.

Jim
ems-safety.com

This is a great summary and I will print it out fo...

2006-11-15T09:11:00.000-08:00

This is a great summary and I will print it out for our group. Great technology and great education exists on the topic. I have personally seen great sessions from Kraus, Phalen, Bergenholtz, and Bob Page.

Its great. Thank you =)

2006-05-07T05:08:00.000-07:00

Its great. Thank you =)