3 scenarios demonstrating the benefits of capnography for EMTs

NAEMSP

Waveform capnography provides a non-invasive, accurate assessment of a patient’s ventilatory status

This article originally appeared in the Article Bites blog of the National Association of EMS Physicians and is reprinted here with permission.

By Adrien Quant LP, Hashim Q. Zaidi MD

Editing by EMS MEd Editor James Li, MD (@JamesLi_17)

As discussed in “Should waveform capnography be in the EMT scope of practice?,” under the National EMS Scope of Practice Model (2019), EMTs are expected to initiate several critical airway and breathing interventions for a variety of medical and traumatic conditions. However, in order to evaluate ventilation and perfusion, EMTs must currently rely on lung auscultation and pulse oximetry – both of which have critical limitations [2]. The limitations of lung auscultation and pulse oximetry can be addressed by the introduction of waveform capnography to the EMT scope of practice (Brandt 2010). Here, the benefits of waveform capnography to EMTs and their patients will be discussed.

Waveform capnography is a non-invasive tool that provides a quantitative measure of expired CO2 throughout the respiratory cycle. A small end tidal carbon dioxide (ETCO2) sensor is placed at the patient’s nose or mouth. During inhalation, the ETCO2 sensor reads a baseline CO2 partial pressure. During initial exhalation, the CO2 partial pressure rises sharply as CO2 rich gas arises from the alveoli. As exhalation continues, the CO2 partial pressure plateaus, and then returns to baseline upon inhalation. In a healthy patient, this physiological process produces the usual “table-shaped” waveform with plateau readings of 35-45 mmHg. Lower respiratory system and V/Q abnormalities cause deviations from the expected “table shape” that are easily recognizable and clinically useful.

Once trained in capnometry interpretation, EMTs would gain valuable information that other vital signs cannot quickly provide. Here are three quick scenarios demonstrating the potential benefits of waveform capnography during common EMT-level interventions.

In these scenarios, lung auscultation and pulse oximetry provided the EMTs with insufficient ventilatory information, leading to patient deterioration. However, proper utilization of waveform capnography would have provided the EMTs with the critical information needed to better monitor their patients. Waveform capnography provides a non-invasive, accurate assessment of a patient’s ventilatory status. While the technology is already extensively utilized by ALS prehospital providers, in many rural parts of the United States, an EMT may be the highest level of prehospital care that a patient receives. Why should waveform capnography be limited to ALS providers? Considering its numerous benefits, should we include waveform capnography in the EMT scope of practice?

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The National Association of EMS Physicians (NAEMSP) is an organization of physicians and other professionals partnering to provide leadership and foster excellence in the subspecialty of EMS medicine. The NAEMSP promotes meetings, publications and products that connect, serve and educate its members, and acts as an advocate of EMS-related decisions in cooperation with organizations throughout the country.