Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Waveform Capnography vs. Hubris.

In discussions of confirmation of endotracheal tube placement, some people have suggested that not everybody needs waveform capnography. We have been intubating for decades without waveform capnography.

This is true.

It is also true that we don’t need to intubate. BLS can be good patient care. BLS airway management can be good airway management.

We had been driving cars for decades without seat belts or airbags. The addition of seat belts and airbags is not to be ignored. Few people would want to have a car without these life protecting devices. There is always that idiot who is afraid of being trapped by the seat belt in a burning car, so he refuses to wear a seat belt. Your chances of being trapped in a burning car by a jammed seat belt, and being too stupid to figure out how to loosen the belt are ridiculously small. But, if you are one of these idiots, this misunderstanding actually seems logical – at least to you.

We do have a term for people who crash while not wearing seat belts. They are called patients – if they survive long enough for EMS to arrive. The glass half full approach is to assume that you will not crash. Well, you do not have the ability to control all of the other drivers on the road, all of the animals that eventually decorate the side of the road, or even the ability to control all of the passengers in your vehicle. You may not even have the ability to stay in your seat on a bumpy ride, unless you are wearing a seat belt. Although, if you are endowed with enough hubris, you might think you have all of these abilities.

You may drive for years without having a crash. You may intubate for years without having a tube, where waveform capnography would make a difference. That is, a misplaced tube that would be picked up by capnography, but not by your intentionally limited assessment.

All it takes is one, Killer.

And I call you Killer with all of the appropriate affection and respect for someone who approaches patients with the appearance of competence, the experience that should produce competence, but not the substance of competence, Killer.

What about all of the providers, who lacking your extensive experience, are more likely to miss signs of a misplaced tube, Killer? How long will it take one of them to exceed their capabilities and suffocate a patient with the misguided belief that your limited approach to assessment is acceptable, Killer? What about when your assessment is in error, due to the incorrect assumption that you are too good for waveform capnography, Killer?

Perhaps, I am being too subtle.

Another objection is that waveform capnography is too expensive for small departments to afford. Just put a sign out front that says:

No life is worth the cost of doing the job right!

For a change of pace from my rant, and for an amusing take on the plastic pieces that change color to indicate the presence of CO2 (carbon dioxide), read this post by JB on the Rocks. This comes with a beverage alert.

Barney, End Tidal CO2, and the Anti-Christ