Your 72-year-old male patient, Mr. Appleby, complains of progressive shortness of breath during your assessment. He repeatedly says, “Can’t breathe,” between difficult breaths. Chief complaint established. Now what? Through a rapid, focused exam, you note labored respirations at 22 per minute and diminished bilateral breath sounds with crackles. Or are those faint rales?
Congestive heart failure (CHF) is the most common underlying condition that results in 9-1-1 calls for shortness of breath. It’s a significant medical condition that EMS sees frequently, with new onset and acute exacerbation of chronic CHF results in more than 300,000 hospital admissions yearly. In fact, 50% of CHF patients will be readmitted to the hospital within six months of their last hospitalization—20% within one month. And the overall mortality from CHF is 8%.1
When EMS providers hear the word, “capnography,” most think of such phrases as “ventilation vital sign,” “airway management tool,” “shark fin” and “tube placement.” Although we shouldn’t minimize these important uses of capnography, the additional, powerful assessment capabilities capnography offers are far greater. Capnography can rapidly and accurately alert clinicians to perfusion and/or metabolic problems and provide deeper insight than traditional assessment tools. So let’s broaden the capnography perspective.
You’re called to a residence for a 22-year-old male who’s having trouble breathing. On arrival you locate the patient, who appears to be in acute respiratory distress. He’s sitting in a chair and leaning forward in a tripod position. He has a hard time speaking and states he has a history of asthma and that this latest attack started about 25 minutes ago. He has used his inhaler twice without relief. He tells you he believes that his puffer is empty.
You and your partner are called to a pediatrician’s office for an emergency transfer to a pediatric intensive care center. On arrival at the office, you’re met by the pediatrician who tells you the patient you’re transporting has respiratory syncytial virus (RSV) and “is going to stop breathing.” The pediatrician further states that the patient is in exam 2 with his mom and that you should load and get to the hospital right away. Aircraft are grounded by severe weather, and it’s a 35-minute transport time.
This supplement focuses on how waveform capnography has become a solid standard of care treatment modality. Its use is being expanded daily to offer optimal assessment and care of conscious and unconscious patients.