Additional Considerations

- When in a PCC environment, simple monitoring technologies are able to be used by most providers in each of the provider categories to ensure adequate gas exchange and oxygen delivery. Peripheral oxygen saturation can be measured using a pulse oximeter which provides a measurement of hemoglobin saturation and, by inference, the effectiveness of measures to oxygenate a patient. Ventilation can be monitored with end-tidal carbon dioxide. The use of these tools together in a PCC environment provides estimates of oxygen transport to the cells, tissue metabolism, and adequacy of ventilation.
- Providers in the PCC environment can adopt, implement, monitor, and sustain respiration using concepts of manipulating minute ventilation (respiratory rate multiplied by tidal volume). Put simply, it is the number of times a patient is breathing each minute multiplied by the amount of air breathed in with each breath.
- Support of adequate minute ventilation can be performed in an escalating algorithm with rescue breathing, bag valve mask assisted ventilation, and mechanical ventilation. Each of these methods may require escalation of airway management skills and respiratory skills. Manipulation of any of the variables of minute ventilation will alter gas exchange. Therefore, medical providers in the PCC environment at all levels will need to be competent with the monitoring devices appropriate to their level of training. At a minimum, all providers with specific medical training should be competent to use and interpret the previous paragraph's monitoring devices.
- The causes of respiratory failure can overlap and become confusing. When in doubt and whenever possible, initiate a Telemedicine Consultation for further guidance and input.