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ETC02 monitoring
Wed, 12/16/2009 - 15:52
The other night my crew and I had a 300 lb. intoxicated, intubated patient who fell off a cliff or was assaulted, laceration to the right temporal area, GCS 3 according to the ED doc. He was brought to the ED via BLS ambulance. He was immediately immobilized by the ED and intubated. RSI drugs as follows: Etomidate 20mg, Succinylcholine 12mg, Lidocaine 100mg and Versed 2mg. ETT 7.5 24mm at the teeth, placement was good verified by the post intubation x ray. Vent settings AC Pressure Support VT 750 Rate 14 FI02 100% PEEP 0. I duplicated the vent settings on the transport vent. We use Zoll monitors that require comping the monitor for 02 greater than 60%. That being done the ETC02 cable was zeroed. My initial reading was 37mm Hg. Vital signs were stable and within normal limits, no chest trauma noted on x ray or physical exam, lungs clear and equal. The sending facility does not monitor ETC02 nor did they get ABGs. Lab values were within normal limits except for a blood alcohol of .496 (this could be his normal value. We all know the type).
Shortly after leaving the building I noticed the ETC02 had dropped to 20-22 mm Hg, SA02 100%, no tube disgorgement, no changes in the patients status, equipment was functioning normally. The ambient temperature was mid 20's.
My question is for those of you working in cold climates does the ETC02 value change/drop with drops in temperatures? Is the ETC02 affected by ETOH?
I have been scouring the internet to find the answers but have come up short as has our QI manager. Any suggestions or comments?
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Wt
Submitted by Anonymous on Sat, 01/02/2010 - 12:01.Was just wondering why only 12mg of sux when you said the pts wt was 300lbs
The vent settings you mention
Submitted by Anonymous on Sun, 01/24/2010 - 02:32.The vent settings you mention are a little confusing. Was the pt in a volume control or pressure control mode? Did you set a volume of 750ml? If he is in assist control and he starts to breathe above the set rate every breath he takes is going to be at the volume (or pressure if in pressure control mode) that is set. In other words he will rapidly blow off CO2 if every breath he takes is 750 mls.
my 2 cents
Submitted by Anonymous on Sun, 12/27/2009 - 15:10.Although cold temperatures should not effect the ETCo2 monitor itself, hypothermia WILL cause a lower ETCo2 value. In general we don't necessarily do a good job in the industry in keeping our patients warm during cold weather transports. I think this especially applies to intubated patients who cant tell us that they are cold. I have done a great deal of research on ETCo2 and I have never come across any research on ETOH effecting the reading. Another issue I have come across in my practice is a contaminated filter giving us a lower value (we have had this issue with ProPak) and if you replace the disposable sensor, you may get a similar number to your original reading.
test
Submitted by Anonymous on Wed, 12/23/2009 - 20:07.test
The vent settings you mention
Submitted by Anonymous on Mon, 12/21/2009 - 16:20.The vent settings you mention are a little confusing. Was the pt in a volume control or pressure control mode? Did you set a volume of 750ml? If he is in assist control and he starts to breathe above the set rate every breath he takes is going to be at the volume (or pressure if in pressure control mode) that is set. In other words he will rapidly blow off CO2 if every breath he takes is 750 mls. Pt needed to be either further sedated (+/- paralytics) or placed in an SIMV mode with maybe pressure support added for his own breaths. That way you have more control over the rate he blows off the CO2.
test
Submitted by Anonymous on Wed, 12/23/2009 - 20:08.testing
I asked one of our med crew
Submitted by Michael on Fri, 12/18/2009 - 08:50.I asked one of our med crew and she said no and no. It likely resulted from the patient starting to wake back up. But then at shift change I asked one of our paramedics and he said yes and yes, temperature affects, though not in a large degree and not during such a short exposure, the elements your talk of. Great posting. Merry Christmas.