Must Reads, Opioid Safety, Respiratory Compromise

What Emergency Medical Services Can Teach Us About Keeping Patients Alive & Capnography

Chris Cebollero, a nationally recognized emergency medical services (EMS) leader, author, and advocate recently wrote an article, “Capnography: What EMS chiefs and leaders need to know”. In this article, Mr. Cebollero writes about how capnography may improve patient care and outcomes:

While assessing patients, the knowledge we gather from vital signs allows our clinicians to make precise diagnoses and employ the appropriate management and treatment. Capnography is often referred to as the seventh vital sign, and can be used in intubated and nonintubated patients. Combining all vital sign information, especially as they change over time, allows our personnel to drill down on both ventilation and perfusion status.

A great example of using capnography to assess a patient is Howard Snitzer.

To see the Mayo Clinic video on Howard Snitzer and capnography, please go to https://www.youtube.com/watch?v=IsPq3oQZGNs&feature=youtu.be

To see the Mayo Clinic video on Howard Snitzer and capnography, please go to https://www.youtube.com/watch?v=IsPq3oQZGNs&feature=youtu.be

In the 2011 article, “Is it possible to survive 96-minutes without a heart beat?”, the Physician-Patient Alliance for Health & Safety (PPAHS) told the story of what happened to Howard:

Howard Snitzer suffered a heart attack outside of a grocery store in Goodhue, Minnesota. Two volunteer paramedics responded and began a 96-minute CPR marathon involving 20 others, who took turns pumping his chest.

Generally, if a victim’s pulse has not returned after 45 minutes of CPR, resuscitation is discontinued. However, fortunately for Howard, the paramedics were using capnography, a “monitoring device that measures the concentration of carbon dioxide in exhaled air and displays a numerical readout and waveform tracing.

Research by Dr. Roger White of the Mayo Clinic and others shows that if the maximum CO2 pressure achieved during 20 minutes of CPR is 14 or less, resuscitation is almost certainly futile. If the level is above about 25, “you need to keep working at it until you’ve exhausted all of your tricks,” Dr. White said.

Based on Howard’s capnography readings, the paramedics continued and were able to resuscitate Howard after the 96th minute. 

Five years later, PPAHS has continued to tell the story of the role of capnography and continuous electronic monitoring may play in keeping patients alive.

In a recent interview with Richard Kenney, MSM, RRT, NPS, ACCS, RCP (Director, Respiratory Care Services, White Memorial Medical Center), PPAHS looked into how Adventist Health hospitals have been able to reduce rapid response calls and improve patient safety and health outcomes. Mr. Kenney says using capnography monitoring has reduced rapid response calls by more than 50%. To view the interview with Mr. Kenney, please click here.

Mr. Cebollero believes that capnography is a transcendent technology for EMS:

The use of capnography is the best tool for EMS field since the 12-lead EKG. This technology will assist your field providers in determining life-threatening conditions not only in the lungs, but also in the cardiovascular system. The use of waveform capnography has transcended the way providers diagnose, manage, treat and also determine whether treatment is working.

For more resources on capnography by EMS providers, please see:

 

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