The 2010 AHA Guidelines for CPR and ECC have a major new Class I recommendation for use of quantitative waveform capnography for confirmation and monitoring of endotracheal (ET) tube placement. Real-time monitoring and optimization of CPR quality using physiologic parameters, such as partial pressure of end-tidal carbon dioxide (PEtCO2), are encouraged. The guidelines also recommend the use of capnography PEtCO2 values to monitor CPR quality, detect return of spontaneous circulation and guide vasopressor therapy during cardiac arrest (Class IIb).
The goal of this supplement is to review key aspects of capnography, its powerful assessment capabilities on intubated and conscious patients, and its importance as a prehospital triage and treatment guiding tool.
Most prehospital providers don’t consider the delivery of EMS a business. They feel they’re in the “business” of saving lives, not money. But in these current economic conditions, EMS managers are being forced to evaluate cost-saving measures for their agencies. One common dilemma is how to maximize care at minimum cost. Another is making necessary budget cuts without reducing patient services. The solution: Use a cost-benefit analysis.
It’s fall—also known as respiratory season—and you’re responding to an emergency call for a 50-year-old male patient who has severe shortness of breath. On scene, you’re met by an excited woman who’s yelling, “Hurry! He’s really bad this time.” You get a déjà vu feeling.
As a relatively new nurse working in the emergency department, I remember a cardiologist who would come by before making his hospital rounds. He’d throw an ECG strip down on the desk, give us a quick scenario and ask, “What is it?” It was always an interpretation that would look obvious but involve more than met the eye. So when we’d give him a quick, but incorrect, answer, he’d respond with, “Gotcha!” He’d then explain the correct answer and be on his way.