Guest guest Posted December 10, 2006 Report Share Posted December 10, 2006 What is the role of the ECG in diagnosing acute pulmonary embolism? Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 11, 2006 Report Share Posted December 11, 2006 Gene, I believe the most ECG can be used to diagnose is to rule out MI or ischemia as far as the pt having sudden onset of CP/SOB. > > What is the role of the ECG in diagnosing acute pulmonary embolism? > > Gene G. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 Can you elaborate on that for us? Gene > > ETCO2 is the way to got for that..... > > Chris > > wegandy1938@wegandy wrote: > What is the role of the ECG in diagnosing acute pulmonary embolism? > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 ETCO2 is the way to got for that..... Chris wegandy1938@... wrote: What is the role of the ECG in diagnosing acute pulmonary embolism? Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 What would you see with the ETCO2? > What is the role of the ECG in diagnosing acute pulmonary embolism? > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 Well, I do too, but I am unclear how it fits into the scenario. Can you elaborate? Gene > > I love ETCO2!!!!!!!I love ETI love ETI love ETI love > > Weinzapfel wrote: ETCO2 is the way to got for > that..... > > Chris > > wegandy1938@wegandy wrote: > What is the role of the ECG in diagnosing acute pulmonary embolism? > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 I love ETCO2!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Weinzapfel wrote: ETCO2 is the way to got for that..... Chris wegandy1938@... wrote: What is the role of the ECG in diagnosing acute pulmonary embolism? Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 Gene - I'm not the in question, but, let me throw this out this way.in pulmonary embolism you have a ventilation-perfusion mismatch which will manifest itself as a sudden decrease in CO2 exhalation. For non-transport providers I don't know that they can use capnography itself to diagnose (field diagnosis) of PE because lab values can make the thought much more definitive, however, capno with a good thinking cap can point you in the right direction. A quick refresh for those of you at home playing along tonight, we know that capnography is the measurement of exhaled carbon dioxide, however, the capno number isn't the whole shebang right? For instance we know that when we breathe in air there should be an amount of CO2 that is very near zero. While some of the air fills the alveolar sacs and gas exchange occurs, including the transferrance of CO2, some of it never makes it - it ends up as dead space ventilation. We know that in some patients, those with PE come to mind, they are not able to perfuse.they ventilate okay, but they don't perfuse. Hence the lung may expand but gas isn't moving. Those alevioli that don't perfuse will mix with those that due and you will end up with a diluted CO2 number, i.e. a decreased CO2 output. If you have ABGs then you can compare your ETCO2 to your PaCO2 and check your gradient. The more dead space, the higher the gradient between ETCO2 and PaCO2. Of course, a low CO2 number can mean a bunch of things such as hyperventilation too, but, if ventilation is staying the same and there is a sudden drop in CO2, or perfusion, then one of the things you should consider would be PE, along with shock (the whole cellular perfusion definition) and lower cardiac output. In all these cases there is a perfusion problem and now it is the practitioner's role to go figure out why. Does this explanation make sense? I am re-reading this and not sure I am getting my point across. S. Suprun Jr. Director of Education Consurgo http://www.consurgo.org Prepare * Respond * Overcome Re: ECG changes in PE Can you elaborate on that for us? Gene In a message dated 12/12/06 1:48:31 PM, ctacdoc657 (AT) yahoo (DOT) <mailto:ctacdoc657%40yahoo.com> com writes: > > ETCO2 is the way to got for that..... > > Chris > > wegandy1938@wegandy wrote: > What is the role of the ECG in diagnosing acute pulmonary embolism? > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 13, 2006 Report Share Posted December 13, 2006 Dx a PE is not as easy as some might think. There have been many shifts in thinking over the years as to what the " Gold Standard " should be. Unfortunately ETCO2, is not that reliable in itself in Dx a PE. There are way too many varaibale. I guess if it was a massive saddle embolus then there would be a decreased ECO2. All you guys are on target though as You must have a high index of suspicion. The history is probably the most valuable bit of info. It seems I remember from my surgical rotation, that although we have advanced with all these new tools in trying to Dx a PE, The morbidity rate has not changed in as many years in those who actually suffer a massive PE. I am curious, does any system have a field EMS protocol addressing PE? If so what do you do for them in the field? Lovenox? Heparin? Does anyone do point of care testing for D-Dimer? (not sure that test exists...) Good Topic for discussion, , NREMT-P, PA-C wegandy1938@... wrote: Well, I do too, but I am unclear how it fits into the scenario. Can you elaborate? Gene > > I love ETCO2!!!!!!!I love ETI love ETI love ETI love > > Weinzapfel wrote: ETCO2 is the way to got for > that..... > > Chris > > wegandy1938@wegandy wrote: > What is the role of the ECG in diagnosing acute pulmonary embolism? > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 13, 2006 Report Share Posted December 13, 2006 Worked for me...great information Chris...Thanks Jules Re: ECG changes in PE Can you elaborate on that for us? Gene In a message dated 12/12/06 1:48:31 PM, ctacdoc657 (AT) yahoo (DOT) <mailto:ctacdoc657%40yahoo.com> com writes: > > ETCO2 is the way to got for that..... > > Chris > > wegandy1938@wegandy wrote: > What is the role of the ECG in diagnosing acute pulmonary embolism? > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 13, 2006 Report Share Posted December 13, 2006 It would depend upon the size and extent of the emboli, wouldn't it? The reason that perfusion is altered is that the pressure gradients between alveolar gas and blood gas is lessened in the affected circulation. So you might see a big drop in exhaled CO2 in the event of a massive PE, but you would also probably be seeing frank hypoxia also. If there is still circulating blood in the majority of the capillaries in the lungs, then you wouldn't see as much drop, would you? So it seems to me that ETCO2 readings might be in the same category as ECG changes. There, but what do they tell you? Gene > > Gene - > > I'm not the in question, but, let me throw this out this way.in > pulmonary embolism you have a ventilation- pulmonary embolism you have > manifest itself as a sudden decrease in CO2 exhalation. For > non-transport providers I don't know that they can use capnography > itself to diagnose (field diagnosis) of PE because lab values can make > the thought much more definitive, however, capno with a good thinking > cap can point you in the right direction. > > A quick refresh for those of you at home playing along tonight, we know > that capnography is the measurement of exhaled carbon dioxide, however, > the capno number isn't the whole shebang right? > > For instance we know that when we breathe in air there should be an > amount of CO2 that is very near zero. While some of the air fills the > alveolar sacs and gas exchange occurs, including the transferrance of > CO2, some of it never makes it - it ends up as dead space ventilation. > We know that in some patients, those with PE come to mind, they are not > able to perfuse.they ventilate okay, but they don't perfuse. Hence the > lung may expand but gas isn't moving. Those alevioli that don't perfuse > will mix with those that due and you will end up with a diluted CO2 > number, i.e. a decreased CO2 output. If you have ABGs then you can > compare your ETCO2 to your PaCO2 and check your gradient. The more dead > space, the higher the gradient between ETCO2 and PaCO2. > > Of course, a low CO2 number can mean a bunch of things such as > hyperventilation too, but, if ventilation is staying the same and there > is a sudden drop in CO2, or perfusion, then one of the things you should > consider would be PE, along with shock (the whole cellular perfusion > definition) and lower cardiac output. In all these cases there is a > perfusion problem and now it is the practitioner' perfusion problem and > why. > > Does this explanation make sense? I am re-reading this and not sure I > am getting my point across. > > > > > S. Suprun Jr. > Director of Education > Consurgo > http://www.consurgohttp > Prepare * Respond * Overcome > > > > Re: ECG changes in PE > > > > Can you elaborate on that for us? > > Gene > In a message dated 12/12/06 1:48:31 PM, ctacdoc657 (AT) yahoo (DOT) > <mailto:ctacdoc657%mailto:ctac> com writes: > > > > > ETCO2 is the way to got for that..... > > > > Chris > > > > wegandy1938@ wegandy1938@ > > What is the role of the ECG in diagnosing acute pulmonary embolism? > > > > Gene G. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 13, 2006 Report Share Posted December 13, 2006 I kinda started this and had to be away from the computer for a few days, sorry S, but I appreciate you picking up my slack; Gene, you are correct, the reality is treatment modalities are not changed, however when looking for why a young patient is exhibiting S/S that have you going, what next or what the heck is going on, to see a normal ETCO2 wave form and numerical value that is less than say 30-35 or as low as 25 with a normal RR, could be a small disruption to massive disruption or block in the Profusion of blood to the lungs as see w/ PE. ETCO2 readings are so sensitive as you know they detect some of the smallest changes before we would ever see them with our naked eye or manual assessment techniques. The a-a gradiant is there but in most cases is so small in the average person it would have a minimal impact.... I am not the expert on this but I have seen 3 very significant patient senarios where the ETCO2 gave ER doc's the important piece of the puzzle while awaiting the ER's ABG in the case of PE's. W wegandy1938@... wrote: It would depend upon the size and extent of the emboli, wouldn't it? The reason that perfusion is altered is that the pressure gradients between alveolar gas and blood gas is lessened in the affected circulation. So you might see a big drop in exhaled CO2 in the event of a massive PE, but you would also probably be seeing frank hypoxia also. If there is still circulating blood in the majority of the capillaries in the lungs, then you wouldn't see as much drop, would you? So it seems to me that ETCO2 readings might be in the same category as ECG changes. There, but what do they tell you? Gene > > Gene - > > I'm not the in question, but, let me throw this out this way.in > pulmonary embolism you have a ventilation- pulmonary embolism you have > manifest itself as a sudden decrease in CO2 exhalation. For > non-transport providers I don't know that they can use capnography > itself to diagnose (field diagnosis) of PE because lab values can make > the thought much more definitive, however, capno with a good thinking > cap can point you in the right direction. > > A quick refresh for those of you at home playing along tonight, we know > that capnography is the measurement of exhaled carbon dioxide, however, > the capno number isn't the whole shebang right? > > For instance we know that when we breathe in air there should be an > amount of CO2 that is very near zero. While some of the air fills the > alveolar sacs and gas exchange occurs, including the transferrance of > CO2, some of it never makes it - it ends up as dead space ventilation. > We know that in some patients, those with PE come to mind, they are not > able to perfuse.they ventilate okay, but they don't perfuse. Hence the > lung may expand but gas isn't moving. Those alevioli that don't perfuse > will mix with those that due and you will end up with a diluted CO2 > number, i.e. a decreased CO2 output. If you have ABGs then you can > compare your ETCO2 to your PaCO2 and check your gradient. The more dead > space, the higher the gradient between ETCO2 and PaCO2. > > Of course, a low CO2 number can mean a bunch of things such as > hyperventilation too, but, if ventilation is staying the same and there > is a sudden drop in CO2, or perfusion, then one of the things you should > consider would be PE, along with shock (the whole cellular perfusion > definition) and lower cardiac output. In all these cases there is a > perfusion problem and now it is the practitioner' perfusion problem and > why. > > Does this explanation make sense? I am re-reading this and not sure I > am getting my point across. > > > > > S. Suprun Jr. > Director of Education > Consurgo > http://www.consurgohttp > Prepare * Respond * Overcome > > > > Re: ECG changes in PE > > > > Can you elaborate on that for us? > > Gene > In a message dated 12/12/06 1:48:31 PM, ctacdoc657 (AT) yahoo (DOT) > <mailto:ctacdoc657%mailto:ctac> com writes: > > > > > ETCO2 is the way to got for that..... > > > > Chris > > > > wegandy1938@ wegandy1938@ > > What is the role of the ECG in diagnosing acute pulmonary embolism? > > > > Gene G. > > > > Quote Link to comment Share on other sites More sharing options...
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