More Doubt about Paramedic Endotracheal Intubation

[Spock]

I agree with you guys on wave form capnography. Frankly, I feel if you do not have this technology you should not be allowed to intubate although I do realize it is expensive. However, the payment to settle the lawsuit for one unrecognized esophageal intubation would pay for the technology along with several ambulances.

I recognize the use of capnography for the nonintubated patient but I'm not sure what it gets you. So the ETCO2 is high; does this mean you can put the patient down and tube him? We mandate the use of capnography for all intubated patients along with recording a strip on the LP 12 at time of intubation and time of arrival in the DEM. Our director won't get the cannulas for the nonintubated patients because of the cost and we can't do anything about a high ETCO2 anyway. We don't have RSI. Also, he said insurance won't pay for it.

Using a c-collar and HID for all intubated patients is an excellent idea and has been reported in the literature. Recording an ETCO2 strip after every move is also a great idea. Here is another: upon arrival at the DEM, have the physician listen to lung sounds and confirm tube placement PRIOR to moving the patient to the hospital bed. San Diego FD does this and wrote about it in a recent edition of JEMS. The first time I did this the doc looked at me like I was a nut but she did it anyway.

Wave form capnography is another example of EMS technology outpacing hospitals. We transport most of our patients to six different hospitals. Only two have capnography in the DEM: one can never find the tubing for their monitor and the other has a unit so old it takes 10 minutes to warm up. Go into most hospital ICU's around Pittsburgh and you will find intubated patients without capnography. I presume it is the same in other parts of the country.

The website for the King airway is www.kingsystems.com. We are forming a Hazmat medical team in Pittsburgh to provide medical support for our 5 Hazmat teams (I know, that is probably four more than we need). We are planning on using the King as our primary airway for use in the hot zone. After decon and movement to the cold zone, we will change this out for an endotracheal tube. I also think it makes more sense to use a King or combitube for the RARE patient that needs airway procedures while entrapped. Every person I have seen with their head through the windshield was dead.

Live long and prosper.

Spock

[Ridryder 911]

Good points Spock, we actually started mandating EtCo2 wave form, ECG and re-verification by medic & Doc..after the move. we use the EtCo2 for multiple purposes such as Co2 retention, differential in noting constriction verses obstruction, as well as noting a changes in DKA. You should detect immediate change on PEA & pacer with capture since EtCo2 immediately changes with perfusion level, way before Sp02 (3-4 minutes) as well as sometimes even a pulse wit poor perfusion's. Of course these are just more diagnostic tools to add to your assessment skills.

I agree, EMS will Have to mandate EtCo2 soon, if we want to continue to intubate. Having documentation, is one way to disprove poor studies and presenting your treatment.

R/r 911