# allergic reaction or anxiety attack???



## addictedforever

Here's a scenario that got conflicting views from the four paramedics who responded. Some tho't an allergic reaction, others tho't just an anxiety attack. I'm curious what your take would be on this one. (I have the right to post this info as I was the pt.)

S-19 y/o f. CC: difficulty breathing. Pt. was cleaning at her work w/ Clorox wipes at 1030 when she had minor SOB then approx 1230 the breathing became a lot worse to what she has never experienced before. Pt states she can't take a deep breath. Pt denies cardiac cx/pn (side note I tried to tell them that my chest did hurt, but I could barely breathe, let alone talk), swelling of throat or tongue. Pt also c/o dizziness, tingling of face, arms, and legs (my hands, feet, and face were spasming at this point). PMHX: none

O-Arrive on scene to find pt. sitting in chair with severe difficulty breathing. Airway) open, clear. Breathing) Labored, rapid. Circ) Good. EKG) Sinus Tach. CBG) 155. Lungs) clear x 4. Skin) Pink, warm, dry. No rash, hives noted on hands or arms or face.

VS at time of arrival: T-97.5 F, P-150, R-44, B/P-118/30, SaO2-100/RA, ETCO2-11 
VS in 15 min: B/P-153/77, P-125, R-45, SaO2-100/2L via NC, ETCO2-12
VS at ER: B/P-130/76, P-106, R-37, SaO2-100/2L via NC, ETCO2-12


----------



## MrBrown

No cardiovascular, respiratory or integumentary symptoms and an increasing blood pressure leads Brown to say this is not anaphylaxis.

Could have been a panic attack but Brown does not see any sort of stimuli 

Most likely cause is the bleach 

... and why in the bloody hell where there FOUR IC's at this job?


----------



## addictedforever

Only thing is Mr. Brown the Clorox wipes had no bleach in them. I am allergic to Bleach. It was some other chemical in them that triggered it. And it happened again, now I avoid them at all costs.

As far as the four paramedics...I have absolutely no clue!!! I was quite shocked! Two came in the ambulance and two on a firetruck. I really don't know, unless they were all bored and this was the most exciting thing that day. LOl


----------



## abckidsmom

I wouldn't call it a panic attack or an allergic reaction.  Sometimes chemical stimuli can trigger a reactive airway, and then the anxiety of that feeling can spin the drama right out of control.

I believe I could sit here and breathe 44 times a minute, shallowly as if my airway feels tight and burns, and could approximate those vitals.

I'm not saying you were faking it, or there wasn't an actual problem, just that all of those vital signs can be explained by the hyperventilation, and they don't look like an allergic reaction at all.  It is extremely uncomfortable, and anxiety-provoking to have a reactive airway thing going on, and I would say that the problem was related to something along those lines.


----------



## addictedforever

Thanks! I am just curious and trying to learn what all I can. I honestly still don't know for sure what happened that day, just that it did happen again when I was exposed to the same thing. I honestly did not feel any anxiety until my supervisor started freaking out, other than that I felt perfectly calm. But by the time I got to the ER I was mad that I couldn't control my breathing. Cuz I tried everything from ignoring it to holding my breath  nothing worked so I got mad


----------



## flyfisher151

Is there a reason why they did not go non-rebreather @ 15L per minute? Just curious.


----------



## DesertMedic66

flyfisher151 said:


> Is there a reason why they did not go non-rebreather @ 15L per minute? Just curious.



Her O2 stats were at 100% on room air. O2 isn't going to help her stats because they are already at 100%


----------



## Aidey

addictedforever said:


> Here's a scenario that got conflicting views from the four paramedics who responded. Some tho't an allergic reaction, others tho't just an anxiety attack. I'm curious what your take would be on this one. (*I have the right to post this info as I was the pt.*)





addictedforever said:


> Only thing is Mr. Brown the Clorox wipes had no bleach in them. *I am allergic to Bleach. It was some other chemical in them that triggered it.* And it happened again, now I avoid them at all costs.
> 
> As far as the four paramedics...I have absolutely no clue!!! I was quite shocked! Two came in the ambulance and two on a firetruck. I really don't know, unless they were all bored and this was the most exciting thing that day. LOl



Um, it is against the rules to ask for medical advise, and asking us to diagnose you is pretty much the same thing. 




flyfisher151 said:


> Is there a reason why they did not go non-rebreather @ 15L per minute? Just curious.



Because that would have been totally unnecessary and probably made her worse? The use of ANY supplemental oxygen in a patient with those vital signs could be questionable.


----------



## addictedforever

I'm sorry, Aidey, I did not mean to ask about medical advice. Since I have seen an MD about it, I just wanted to know what other paramedics would do if presented with this same scenario.


----------



## 18G

Nothing rings out an allergic reaction. It sounds like what ABCkidsmom had said about maybe a SOB feeling instilling some anxiety which spiraled out of control. 

Looking at the vital signs the HR was initially 150, resp rate of 44, EtCO2 of 11 plus "c/o dizziness, tingling of face, arms, and legs (my hands, feet, and face were spasming at this point)" this all equals hyperventilation syndrome. By the time you arrived at the ED HR was 106. An allergic reaction would not present with a spontaneously decreasing HR. 

So yeah, anxiety induced hyperventilation.

flyfisher151... this patient did not require ANY supplemental oxygen let alone 15lpm by NRB.


----------



## flyfisher151

Thanks for the answer firefite! I just learned something. Funny how when you are in school, all this info is jammed in your head, but it takes a real scenario to stick it there and glue things together.


----------



## johnrsemt

4 Medics:  I have been on runs that was dispatched ALS ambulance and Engine  (chest pain, trauma, resp distress, allergice reaction  all get engine crew also):  and have had 2 medics on the amb and 4-5 on engine.  Makes  patient care easy if you talk about it in advance:  IV person, Drugs, Airway, Cot, family care.

   Why does everyone think that it is NOT an allergic reaction because the patient doesn't have hives?  I get hives around cat dander:  I have Never gotten hives with Anaphalaxys for my Nut Allergies.  I have had dr's and Medic's tell me that I was NOT having an allergic reaction due to no hives:  they changed their story when Epi and Benadryl fixed my problem after I stopped breathing.  Also when the Staff Doc yells at them for not listening to the patient and letting me stop breathing.


----------



## Aidey

No one is saying it wasn't an allergic reaction because of the lack of hives. There are other things, like the vital signs, that indicate it was not an allergic reaction.


----------



## sir.shocksalot

Aidey said:


> No one is saying it wasn't an allergic reaction because of the lack of hives. There are other things, like the vital signs, that indicate it was not an allergic reaction.



What about the vitals leads you to believe it wasn't an allergic reaction? I  wasn't aware vital signs necessarily changed in allergic reactions.


----------



## CaydenElizalde

I'm not tempted really to believe it was initially an anxiety issue or an allergic reaction. I've personally attempted to clean things out like my shower or other such things with Clorox and after inhaling a bit too much of the chemicals that released into the air from the surface, I noticed that I was having some serious problems breathing and chest pain from coughing. Maybe it was just a bit of anxiety brought on by a "chemically induced" respiratory distress. :\


----------



## addictedforever

18G said:


> Nothing rings out an allergic reaction. It sounds like what ABCkidsmom had said about maybe a SOB feeling instilling some anxiety which spiraled out of control.
> 
> Looking at the vital signs the HR was initially 150, resp rate of 44, EtCO2 of 11 plus "c/o dizziness, tingling of face, arms, and legs (my hands, feet, and face were spasming at this point)" this all equals hyperventilation syndrome. By the time you arrived at the ED HR was 106. An allergic reaction would not present with a spontaneously decreasing HR. QUOTE]
> 
> It did not spontaneously decrease. I was given some sort of drug to make it decrease but I can't remember the name, and I can't read the spelling on the PCR.


----------



## 18G

addictedforever said:


> It did not spontaneously decrease. I was given some sort of drug to make it decrease but I can't remember the name, and I can't read the spelling on the PCR.



The only drug you would have been remotely given to decrease your HR in this situation would be adenosine. And if they gave you adenosine with a sinus tach at 150 someone needs to go back to school.


----------



## Smash

18G said:


> The only drug you would have been remotely given to decrease your HR in this situation would be adenosine. And if they gave you adenosine with a sinus tach at 150 someone needs to go back to school.



I presumed some kind of anxiolytic; the only hoofbeats I'm hearing belong to the anxiety horse, not the anaphylaxis zebra.

As an aside, I have no idea what a tho't is.  Can someone enlighten me?


----------



## usalsfyre

If there was any thought it might be a true allergy issue I might have considered diphenhydramine, covers that base and tends to have a bonus anxiolytic side effect as well. However, I agree with the above assessments, sounds like an acute anxiety issue best treated with a low dose of benzos.


----------



## 18G

A benzo could be given but it would be a rarity to see a benzo given for someone hyperventilating pre-hospital. Not saying that is a good thing but it is what it is.


----------



## usalsfyre

18G said:


> A benzo could be given but it would be a rarity to see a benzo given for someone hyperventilating pre-hospital. Not saying that is a good thing but it is what it is.



It's done on a regular basis here. That said, no service around us does it.


----------



## crazycajun

Alkyl dimethyl benzyl ammonium chloride is a major ingredient in Clorox wipes. Most people allergic to bleach are allergic to the high concentrations of Sodium and Ethyl Chlorides. Because both of these products are found in raw chlorine PT's allergic to bleach are often allergic to other cleaners containing chlorides. My diagnosis would be Anaphlaxis but I would be interested in the meds administered.


----------



## Aidey

crazycajun said:


> Alkyl dimethyl benzyl ammonium chloride is a major ingredient in Clorox wipes. Most people allergic to bleach are allergic to the high concentrations of Sodium and Ethyl Chlorides. Because both of these products are found in raw chlorine PT's allergic to bleach are often allergic to other cleaners containing chlorides. My diagnosis would be Anaphlaxis but I would be interested in the meds administered.



2 hour onset time.


----------



## medicsb

Based on the information provided it sounds to me like a panic attack.  I would've tried to coach the patient to control their breathing and then coach BLS to coach the patient as I'd release to BLS.  Though, I have stuck around and treated a panic attack or two with ativan in extreme cases.


----------



## TxParamedic

My wife used to present just like this. Sensitivity to some chemical paired with anxiety and yehaw! She has since learned to control her anxiety to the point she can avoid hyperventilation and hasn’t landed in the ED since. She still can have SOB if she gets around some chemicals but she gets away from them and doesn’t panic and recovers quickly. Only took about a decade of coaching from her Doc and myself!


----------



## addictedforever

crazycajun said:


> Alkyl dimethyl benzyl ammonium chloride is a major ingredient in Clorox wipes. Most people allergic to bleach are allergic to the high concentrations of Sodium and Ethyl Chlorides. Because both of these products are found in raw chlorine PT's allergic to bleach are often allergic to other cleaners containing chlorides. My diagnosis would be Anaphlaxis but I would be interested in the meds administered.



I'd tell you if I could, but I don't remember the meds. But that's the chemical that was in it. I couldn't remember, but that's it!



medicsb said:


> Based on the information provided it sounds to me like a panic attack.  I would've tried to coach the patient to control their breathing and then coach BLS to coach the patient as I'd release to BLS.  Though, I have stuck around and treated a panic attack or two with ativan in extreme cases.



Well, maybe they would've done BLS to, if they hadn't all been ALS providers  But that's basically what they did. 



TxParamedic said:


> My wife used to present just like this. Sensitivity to some chemical paired with anxiety and yehaw! She has since learned to control her anxiety to the point she can avoid hyperventilation and hasn’t landed in the ED since. She still can have SOB if she gets around some chemicals but she gets away from them and doesn’t panic and recovers quickly. Only took about a decade of coaching from her Doc and myself!



A decade??? Oh boy! Hope I'm a quicker learner than that! LOL  Nope, I avoid chemical cleaners now, especially in tight closed areas.


----------



## ZombieEMT

I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.

I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.


----------



## Aidey

Epi helps in anxiety? Huh?! Epi is the exact wrong thing to give a patient with an anxiety attack. You want to give more epi to a patient who is having an overload of endogenous epi? Why?

All clinical signs indicate this patient has more than adequate gas exchange. More oxygen will cause further decrease in her CO2, which in turn will make her feel worse. Part of training is using good judgement, and using a BVM on this patient IS NOT good judgement. You can try it, but be ready to get punched by the patient.


----------



## abckidsmom

HaleEMT said:


> I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.
> 
> I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.



This is very sweet, but have you ever even SEEN an adult person with a little bit of anxiety breathing 44 times a minute?  I dare ya to get them to sit still on the stretcher, much less let you stand over them, hold a mask to get a seal on their face, and then the *real* fun begins...you try and time your squeezing of the bag to their breathing.  

Good luck.  

Keep reading around here, there is a lot for you to learn.  It's interesting how in one paragraph you promote freelancing with using meds that are not indicated, and in the second paragraph you promote mindlessly sticking to "what you were trained to do."  Nothing like a little paradox to mix your message.  :blink:


----------



## Smash

HaleEMT said:


> I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.
> 
> I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.









I think we just got trolled.  Well, I hope we just got trolled...


----------



## usalsfyre

HaleEMT said:


> An epi-pen can also help in anxiety.


Something tells me you've never seen a patient post-epi administration.



HaleEMT said:


> Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100...


True, but it's FAR more common to get falsely low readings than falsely high. Despite what's taught in every EMT-B class in the country, SpO2 does have value (esp if it displays a waveform) you just have to know how to take it in context.



HaleEMT said:


> especially if they need.


The problem is determining need. Respiratory rate in isolation is as poor a determinate as SpO2



HaleEMT said:


> Flyfisher, why go with a non-breather, where is the BVM.


As abckidsmom notes...good luck. 



HaleEMT said:


> Both of you should stick to your standards of care and scope of practive.


"Standard of care" being a little squirley here. 



HaleEMT said:


> If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level...


Which isn't going to happen on this patient with you holding a BVM to their face...



HaleEMT said:


> ...even if they are unfomfortable on conscious patients.


...for at least the reason of the workout they are going to get stomping a mudhole in your existence while you try this.



HaleEMT said:


> If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.


I withhold treatments I was "trained to do" all the time. Daily in fact. Why? Because it was not medically indicated at that moment in the patients course of care. That's what medical practice is. Anyone who tells you something is an absolute in medicine is full of crap. The important thing is having a sound reason for everything you do, or don't do.


----------



## addictedforever

this thread gets more interesting as it goes along.  I love being able to hear from different paramedics and how they would treat it. I'm learning so much!

And if anyone had tried to put a bvm or nrb on me, i think i truly would've panicked then


----------



## addictedforever

HaleEMT said:


> I want to ask, does it matter. The problem is not whether its anaphylaxis or anxiety attack, the problem is that she is having difficulty breathing. From a BLS end, if all you can do for anaphylaxis is an epi-pen, its only temporary relief. An epi-pen can also help in anxiety attack. Treat the patient and not the disease. If they can not breath fix that. The fact that the patient is not breathing adequately is more pressing than why.
> 
> I also want to address statements by flyfisher and fireflite. Fireflite, a pulse ox is not always accurate, there are things that can give false readings. I would never deny a patient oxygen because a pulse ox says 100, especially if they need. Flyfisher, why go with a non-breather, where is the BVM. Both of you should stick to your standards of care and scope of practive. If someone is breathing at 44bpm, they should have a bvm to assisst with ventilations until they are at a normal level, even if they are unfomfortable on conscious patients. If you do not feel they really need it, just think again because it does not matter. Thats what you were trained to do, that is your standard of care, and that is what should be done.



You sound like a very compassionate person. I think it truly would've been interesting to have you treating me, but I may have truly panicked had you tried a BVM even tho' I would understand what you were doing. I would've just grabbed the rails so tight they woulda popped off


----------



## addictedforever

18G said:


> The only drug you would have been remotely given to decrease your HR in this situation would be adenosine. And if they gave you adenosine with a sinus tach at 150 someone needs to go back to school.



I think they were mostly worried because I have a brother with a rare heart murmur that's genetic.


----------



## shfd739

Im agreeing with the others here. 

Im still surprised by the NRB comment. I was taught 10 years in emtb to interpret the spo2 and also assess the patient. And EpiPen? Wow.

I wouldn't hand off to BLS though. Vitals are too out of norm to feel comfortable doing so or be able to justify it.


----------



## ZombieEMT

So maybe the epi statement was off, and do not get the wrong idea because its not something I would do. However, I have heard stories of epi being used to treat respiratory ending positive when not an allergic reaction. Someting that might seem like an allergic might not actually be an allergic reaction, does that mean that the epi is completely ineffective? Right or wrong, but the epi is treating problems the body is having and not removing an allergen from the body? Is that not why we still transport after epi has been administered.

As for the BVM, I do not feel that I am wrong there. Again, there is a standard of care. How they feel compared to how they actually are is something that we have to considered. I have multiple times bagged a patient in severe respiratory distress and done so successfully. You base your input on what? Have you tried more than once to bag a conscious patient? Have you tried at all or just went with what other people tell you. Talk to your patient, convince them its best, if they really need it. Do you frequently attempt to bag or just always go straight to NRB and ignore the standard. There are standards for a reason. You want to bust on me, but if you havent really tried more than once, you dont really know.


----------



## ZombieEMT

Usalsfye, I do agree with nothing in medicine being definite. 100% true, you treat as the patients needs, its all based on the patient. So for that same reason, shouldn't you treat individual you run into as a new patient rather than what you normally do. If the standard is to treat with a bvm, why not make an attempt. If unsuccessful for any reason at all, even if just incomfortable, feel free to make the decision to remove but why deny from the beginning. Isnt always going against the standard and not bagging, saying there is a definite in that situation. On the same topic, don't we normally treat most analphylaxis with epi, because thats the standard. Again dont get me wrong, I agree 100% that there is no definite, I just do not see why to always sway from standard rather than see where it takes you.


----------



## shfd739

HaleEMT said:


> Usalsfye, I do agree with nothing in medicine being definite. 100% true, you treat as the patients needs, its all based on the patient. So for that same reason, shouldn't you treat individual you run into as a new patient rather than what you normally do. If the standard is to treat with a bvm, why not make an attempt. If unsuccessful for any reason at all, even if just incomfortable, feel free to make the decision to remove but why deny from the beginning. Isnt always going against the standard and not bagging, saying there is a definite in that situation. On the same topic, don't we normally treat most analphylaxis with epi, because thats the standard. Again dont get me wrong, I agree 100% that there is no definite, I just do not see why to always sway from standard rather than see where it takes you.



What standard says you have to use a BVM on this patient?


----------



## Aidey

There are other things to try in allergic reactions besides epi. Especially if there is not strong evidence of anaphylaxis, which there is not in this case.

I also want to know what standard you are talking about. Everything I have read says consider assisting ventilation if respirations are below 8 or greater than 30 and signs of inadequate oxygenation are present. I do not recall ever hearing it was the standard to bag pts breathing more than 30 times a minute. 

For the record I have bagged a conscious patient. I don't do it very often because it isn't often necessary.


----------



## IAems

*BLS is BLS, and ALS is ALS*

From a BLS perspective, Do Not Withhold Oxygen For Any Reason (just like you were trained).  From a BLS level of training, a RR of 44 and HR of 150 of course requires high flow oxygen.  If an EMT-B withheld O2 from a patient and something happened to that patient, that EMT-B would be completely at fault.  That being said, even an EMT-B can monitor how a patient _responds _to an intervention and adjust treatment accordingly.  The damage to be done by withholding oxygen is far greater than the damage to be done by applying it.  However, for a Paramedic, interventions and treatments are different and correspond to that level of training.  To those of you who are Paramedics, unless you're on scene, and it's your patient, please don't tell a Basic to provide your level of care without your level of training.  And those of you who are Basics stating you would withhold oxygen, best of luck explaining in a courtroom why you withheld oxygen from a patient C/O SOB, possible anaphylaxis (in and of itself an indication of high flow O2), RR 44, and HR 150.  I have always taken the approach of _treating _ for the worst case scenario of present symptoms.  That being said, if the throat and tongue are _actually_ swelling (not just reported that way by a panicking patient), I'm going to be a lot more worried about anaphylaxis than anxiety.  To my knowledge, anxiety does not cause swelling.  I've always thought its better to look stupid for doing too much than look stupid for doing to little.  Just in theory, how much higher do you let the RR and HR go before applying oxygen and, I am admitting ignorance in this one, short of minor vasoconstriction, an immediate diagnosis of pulmonary fibrosis, or a chronic history of COPD, what would be the detrimental effects of high flow O2 on this patient?  By the way, how did you get an accurate SaO2 reading anyway?  As I understand, the best we can do in pre-hospital is S_*p*_O2 which has a + or - 4% accuracy of the actual SaO2 (especially without a pleth wave), and is further called into question by the fact that agitation and patient movement reduce accuracy (like for example "hands . . . spasming").  I guess what I'm saying is, you're all probably right and the patient doesn't need oxygen, but if the patient did and an EMT withholds it, wouldn't that be much worse?


----------



## ZombieEMT

The Department of Transportation, which as I last checked, is responsible for EMS on the federal level, but maybe I am wrong. Maybe the DOT just has these standards that they set and print, but in reality they mean nothing and that all real EMS providers should ignore them. If thats what you were looking for.


----------



## ZombieEMT

Aidey said:


> Everything I have read says consider assisting ventilation if respirations are below 8 or greater than 30 and signs of inadequate oxygenation are present. I do not recall ever hearing it was the standard to bag pts breathing more than 30 times a minute.



I do not know if this was a typo but it seems as if you are contradicting yourself. First sentance states you have read that you do assisst over 30 but second states you have never heard of doing so. Also, I do not kow if you read my earlier posts, but I am not suggesting we bag just to bag but rather bag when needed. I am not going to force a bag on someone that does not need it. Its not like I like to bag a patient or make them uncomfortable, but if need be done, its done.


----------



## Aidey

HaleEMT said:


> I do not know if this was a typo but it seems as if you are contradicting yourself. First sentance states you have read that you do assisst over 30 but second states you have never heard of doing so. Also, I do not kow if you read my earlier posts, but I am not suggesting we bag just to bag but rather bag when needed. I am not going to force a bag on someone that does not need it. Its not like I like to bag a patient or make them uncomfortable, but if need be done, its done.



I did not contradict myself. I said I had read one should CONSIDER assisting ventilation when there are indications of inadequate gas exchange and respirations are below 8 or above 30. What I have never heard is anything declaring it is a standard to use a BVM on anyone with respirations over 30. It is an option if indicated, not a standard. It also is not indicated in the scenario posted in the OP.


----------



## usalsfyre

HaleEMT said:


> So maybe the epi statement was off, and do not get the wrong idea because its not something I would do. However, I have heard stories of epi being used to treat respiratory ending positive when not an allergic reaction. Someting that might seem like an allergic might not actually be an allergic reaction, does that mean that the epi is completely ineffective? Right or wrong, but the epi is treating problems the body is having and not removing an allergen from the body? Is that not why we still transport after epi has been administered.


You have to have a somewhat firm differential before you start tossing medications around. If your patient is SOB due to cardiac issues and you administer epi, you have just made your patients day a lot worse. Not like "the hospital can fix it" worse, like DWPA (Death With Paramedic Assistance) malpractice bad. So epi, like many meds, is life saving when used correctly, deadly when not.  



HaleEMT said:


> As for the BVM, I do not feel that I am wrong there. Again, there is a standard of care. How they feel compared to how they actually are is something that we have to considered.


Yep....but not how your thinking. I have not, in ten years and countless patient contacts, seen a respiratory patient who felt fine but was about to die. All of the really sick ones looked and felt...like they were about to die. Maybe this patient exist, but they're in such a small minority that you can't base practice around it. Converesely, I've seen a whole crapload of patients who felt like they were going to die, but they were actually of low acuity/not that bad when a good assesment was performed. Still needed treatment, but not the full court press. 




HaleEMT said:


> I have multiple times bagged a patient in severe respiratory distress and done so successfully.


Define successfully. Asynchronous breaths where the patient is uncomfortable  and fighting is not, in my mind, success. 



HaleEMT said:


> You base your input on what? Have you tried more than once to bag a conscious patient? Have you tried at all or just went with what other people tell you..


Yep, once or twice . I base my input on the fact that it a)didn't work all that well b)increased the patient's anxiety c)PPV has other kinds of badness associated with it. 



HaleEMT said:


> Talk to your patient, convince them its best, if they really need it.


Uhhhh, it's not best usually. Outside of the ridiculous EMT-Basic assertion, you won't find anyone that says bagging a patient who is otherwise meeting their ventilatory requirement on their own needs a BVM. 



HaleEMT said:


> Do you frequently attempt to bag or just always go straight to NRB and ignore the standard.


Very few of my patients get suplemental O2 at all (THE HORROR!!!:blink. When they do get it, it's because I belive they have a hypoxic hypoxia, which is just about the only thing supplemental O2 actually helps with. Oxygen is not a magic gas that cures all ills.  



HaleEMT said:


> There are standards for a reason.


MAST, Cadilac ambulances, demand valves, intracardiac and high dose epi and bicarb every 5 minutes were the standard at one time too. They were all wrong. 



HaleEMT said:


> You want to bust on me


Not busting on you, trying to educate you that a great deal of the EMT-Basic curriculum is flat out wrong. 



HaleEMT said:


> but if you havent really tried more than once, you dont really know.


I've tried many times. I've got a good experince base as both a medic and a basic to base this on. What your saying is not good for 90% of patients.


----------



## abckidsmom

Smash said:


> I think we just got trolled.  Well, I hope we just got trolled...



I just read that post out loud to my husband.  Holy cow, I'm with you...I hope we got trolled, cause if not...


----------



## MrBrown

IAems said:


> From a BLS perspective, Do Not Withhold Oxygen For Any Reason (just like you were trained).  From a BLS level of training, a RR of 44 and HR of 150 of course requires high flow oxygen.



Yes of course it does, lets shove 15 litres of oxygen down his gob with a non-rebreathing mask!!

You do know that oxygen has proven to be harmful in certain groups of patients given their physiologic response to it right?

Stop doing what your poorly written textbook tells you, it's wrong.


----------



## IAems

*Please Clarify*



MrBrown said:


> You do know that oxygen has proven to be harmful in certain groups of patients given their physiologic response to it right?
> 
> Stop doing what your poorly written textbook tells you, it's wrong.



I am more than open to education.  Please, Cite some _EMS specifc_ studies or sources and I would be more than happy to read them.  And please don't cite the recent UCLA studies on O2 Therapy on pediatric patients as I have both read it and feel that that study pertains more to _pediatric_ patients, which this patient is not.  Like I said, "I am admitting ignorance in this one, short of minor vasoconstriction, an immediate diagnosis of pulmonary fibrosis (not in this patient's history), or a chronic history of COPD (not in this patient's history, and even if it was, the hypoxic drive will generally take longer than 30 minutes to be effected), what would be the detrimental effects of high flow O2 on this patient?"  I guess more specifically, what, in this particular scenario, is the contraindication of O2 Therapy? Because the multiple complaints (SOB, Tachycardia, Tachypnea, and Anaphylaxis) can all be improved by O2 Therapy and are _each individually_ indicative of O2 Treatment.  And again, "an EMT-B can monitor how a patient responds to an intervention and adjust treatment accordingly".


----------



## usalsfyre

IAems said:


> Please, Cite some _EMS specifc_ studies or sources..


I'm on the run, so I can't look them up the studies refered to right now, but why must they be "EMS specific"? Do medications (including O2) somehow work differently outside the confines of the hospital?


----------



## IAems

*Definitive vs. Pre-hospital*

Definitive care is, by its very nature, different from pre-hospital care.  We do not treat for long term, we stabilize patients to the best of our ability in an effort to get patients _to_ definitive care.  Most of the cautionary tales of hyperoxygenation and withholding O2 come from the definitive care setting (RN's, MD's, PA's, and NP's not educated in the pre-hospital field).  And YES, I completely agree that for a definitive / long-term care patient, hyperoxygenation is a very bad thing.  However, in a pre-hospital care setting, where, theoretically, the time spent with patient should be limited to a few hours at worst, it should not be a consideration, especially in a heavily urbanized area where a hospital is always a few miles away.


----------



## usalsfyre

IAems said:


> Definitive care is, by its very nature, different from pre-hospital care.


Here is where I fundamentally disagree with you. Medicine is medicine, no matter if it's practiced on an ambulance, in an ICU, at an LTC or in a tent. Trying to say otherwise is making excuses.



IAems said:


> We do not treat for long term, we stabilize patients to the best of our ability in an effort to get patients _to_ definitive care.  Most of the cautionary tales of hyperoxygenation and withholding O2 come from the definitive care setting (RN's, MD's, PA's, and NP's not educated in the pre-hospital field).


You do realize things you do initally on a call may have effects days and weeks later right?



IAems said:


> And YES, I completely agree that for a definitive / long-term care patient, hyperoxygenation is a very bad thing.  However, in a pre-hospital care setting, where, theoretically, the time spent with patient should be limited to a few hours at worst, it should not be a consideration, especially in a heavily urbanized area where a hospital is always a few miles away.


What your saying is "I know it's not good, but I'm not confident enough in my assesments to withhold oxygen and I'm relying on my short contact with the patient to prevent harm". A few hours CAN do bad thing. There's no reason for superphysiologic levels of oxygen for 99.99% of patients. Doing so, even in the short term, can cause harm. Why not perform better assesments so you don't have to risk harm?


----------



## Aidey

The body was designed to homeostase under certain parameters. Why screw with those parameters if you don't have to? The ambulance and what we do in it does not exist out of the space-time continuum. If hyper-oxygenation is a bad thing in a hospital, or nusing home, it is a bad thing in an ambulance. What we do will affect the patient, and there is absolutely no point in doing something that is not indicated.


----------



## crazycajun

Aidey said:


> 2 hour onset time.



PT stated onset of SOB at the time of using wipes. PT stated it had gotten worse 2 hours later. Inhaled/absorbed chemicals affect PT's differently. I have seen onset immediate that was minor from chlorine exposure w/ SOB, sweats. PT rapidly deteriorated 3.5 hours later and went full cardiac arrest. Think of some chemical reactions like snake venom. The longer the toxin goes untreated the worse it gets.


----------



## 18G

When are EMS instructors going to stop teaching EMT-B students that oxygen is harmless!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Oxygen in high concentrations HAS BEEN FOUND TO BE HARMFUL IN MI, CVA, NEONATAL RESUSCITATION, AND ROSC. The research is out there, GOOGLE IT. 

Oxygen therapy is a BLS skill area... learn to do it appropriately. 

And no, a resp rate alone is not a sole reason to "bag" someone especially if the cause (ie anxiety) is expected to only be transient and quickly improved. I have found pulse oximeter's to have an overall high degree of accuracy and are accurate more times than not.


----------



## IAems

*Again, please clarify*



usalsfyre said:


> What your saying is "I know it's not good, but I'm not confident enough in my assesments to withhold oxygen and I'm relying on my short contact with the patient to prevent harm". A few hours CAN do bad thing. There's no reason for superphysiologic levels of oxygen for 99.99% of patients. Doing so, even in the short term, can cause harm. Why not perform better assesments so you don't have to risk harm?



Becuase I knew someone would so this, I did google it.  Let me illustrate how to cite a scientific quote.  Refer to: http://docs.google.com/viewer?a=v&q=cache:GZ7jcY8rinUJ:medind.nic.in/jac/t03/i3/jact03i3p234.pdf+Patel,+Dharmeshkumar+N%3B+Goel,+Ashish%3B+Agarwal,+SB%3B+Garg,+Praveenkumar%3B+Lakhani,+Krishna+K+%282003&hl=en&gl=us&pid=bl&srcid=ADGEESi0EspwNsX6RYofhkF28qziMiq4_GQLiSJ_L8giNKUbmXR5JwEglxw85da4jusKiKrA8Kh-KRYiJBI6jk5KNjLzfV-fL7rNt7HVw6BdxKAJS_8rEGbVMox_HsN62D4xccNm_88h&sig=AHIEtbTBrTJwCOW9B1OzmfKWkXUDKWv4pQ

Specifically, please refer to the "Clinical Features" subsection which states, "100% oxygen can be tolerated at sea level for about 24 - 48 hours without any serious tissue damage.  There is mild carinal irritation on deep inspiration after 3 - 6 hours of exposure of 2 ATA oxygen . . . [however] in the majority of patients, these symptoms subside 4 hours after cessation of exposure."

When my EMS instructor and preceptor explained the merit of oxygen therapy, it was done so with scientific reasoning, which, though I have asked for, I have not seen despite reading multiple threads on this and other sites regarding this topic.  I am very confident in my assessment, and I am not going to withhold a therapy mandated by my local protocols, my Medical Director, and my medical knowledge which is further enforced by both the AAOS and Brady Pre-Hospital Care texts as well as the aforementioned study, unless someone here cites some sort of scientific evidence that suggests I do so.  Please, if you know something I don't, let me in on it.  However, if you do not, don't espouse the benefits of withholding therapies if you can't support your decision to do so.


----------



## Handsome Rob

*Google it!!!*



18G said:


> When are EMS instructors going to stop teaching EMT-B students that oxygen is harmless!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
> 
> Oxygen in high concentrations HAS BEEN FOUND TO BE HARMFUL IN MI, CVA, NEONATAL RESUSCITATION, AND ROSC. The research is out there, GOOGLE IT.
> 
> Oxygen therapy is a BLS skill area... learn to do it appropriately.
> 
> And no, a resp rate alone is not a sole reason to "bag" someone especially if the cause (ie anxiety) is expected to only be transient and quickly improved. I have found pulse oximeter's to have an overall high degree of accuracy and are accurate more times than not.



I'm more than a little concerned that all of the paramedics here are nay-saying what is taught and telling the basics to move away from instructive texts, which I'm absolutley fine with WHEN YOU TELL THEM WHY! 

"Google It" tells me one of two things: you either do not know what you are talking about and trying to be cool like the rest of the people who are saying whatever, or you are too lazy to take the time to instruct your junior healthcare providers and have no business on an 'educational' forum.


----------



## 18G

Handsome Rob said:


> I'm more than a little concerned that all of the paramedics here are nay-saying what is taught and telling the basics to move away from instructive texts, which I'm absolutley fine with WHEN YOU TELL THEM WHY!
> 
> "Google It" tells me one of two things: you either do not know what you are talking about and trying to be cool like the rest of the people who are saying whatever, or you are too lazy to take the time to instruct your junior healthcare providers and have no business on an 'educational' forum.



Actually... the reason I didn't spell out the research was because it has already been stated numerous times before on the forum AND I was in the middle of doing something else which didn't permit me to type a long reply with the research. 

I don't always have someone hand feed me the information... I look it up for myself so I suggest you do the same. 

I'll at least give you a head start on your research:

- CVA: AHA recommends mild-moderate CVA patients receive only room air. Evidence suggests better outcomes than when these patients receive oxygen. 

- MI: Research dating back to the 1950's and recently validated in the 2000's show worsened myocardial ischemia, decreased cardiac output, narrowing of the coronary vessels, and no benefit with oxygen administration. Most MI patients are oxygenating just fine systemically. Oxygen administration has been proven to NOT increase oxygen delivery or reduce tissue death on the other side of the coronary occulsion. 

- Neonatal Resuscitation: The NRP program guidelines were changed to reflect neonatal resuscitation to initially begin with room air only. This is something Europe has been doing forever. The US has been about the only one who insisted on using oxygen. Research shows decreased time to first breath, first cry, and overall better outcomes. 

- ROSC: Oxidative damage as a result of the re-perfusion sends cells to their ultimate death and not restoration as you would think. Research here is ongoing but much evidence suggests minimal O2 titrated to saturation above 94%. 

PA protocols specifically address the new evidence regarding oxygen administration and state to TITRATE OXYGEN ADMINISTRATION to patient needs. It is defined as an SpO2 above 94% and NOT high-flow. 

Under neonatal resuscitation protocol it is also further broken down. A neonate does not present with an SpO2 in the typical normal range. If you check their saturation immediately after birth you will see 60% range, 70% range, etc until their body transitions to the extrauterine circulation.

The reason the SpO2 is broken down is so providers do not administer oxygen unnecessarily to these babies because of the negative effects and that it serves no purpose.  

I have also read research that found COPD patients should have their oxygen saturation titrated to right around their baseline and not 100%. And no... this has nothing to do with that hypoxic drive myth either. 

I spend prob half my time validating what I have been taught. I have even had a ED physician (also a Medical Command physician) along with an RN give me :censored::censored::censored::censored: because I requested orders for captopril (which we carry) in a obvious CHF patient. I asked the doc why I was denied and all he could say was, "generally patients are only on ACE inhibitors for long term use and we don't give them emergently"... I was quite taken back by this response. We carry captopril and evidence suggest much better outcome with early ACE inhibitor use. And not to mention many EMS systems and hospital ED's give early ACE inhibitors for CHF.  They also claimed that no other medic had ever requested orders for captopril. 

You need to take the lead and find out for yourself. Don't play follow the leader and believe everything your textbook says. It's unfortunate the textbook still teaches what it does about oxygen.


----------



## 18G

Oh, and really the only reason EMT textbooks are saying 100% for everyone is because the curriculum does not adequately teach Basics how to assess a patients oxygenation status. So it's a empirical blanket treatment with no evidence to support it.


----------



## usalsfyre

Handsome Rob said:


> I'm more than a little concerned that all of the paramedics here are nay-saying what is taught and telling the basics to move away from instructive texts, which I'm absolutley fine with WHEN YOU TELL THEM WHY!
> 
> "Google It" tells me one of two things: you either do not know what you are talking about and trying to be cool like the rest of the people who are saying whatever, or you are too lazy to take the time to instruct your junior healthcare providers and have no business on an 'educational' forum.



Did it ever occur to you that in telling you to look up the answer, you might learn and retain the information more readily than having it spoon-fed to you? 

I'm well versed on the hows and whys. I got that way through my own research. Perhaps you should try the same.


----------



## Aidey

usalsfyre said:


> Did it ever occur to you that in telling you to look up the answer, you might learn and retain the information more readily than having it spoon-fed to you?
> 
> I'm well versed on the hows and whys. I got that way through my own research. Perhaps you should try the same.



+1

There is immense value is doing your own research.


----------



## usalsfyre

IAems said:


> Becuase I knew someone would so this, I did google it.  Let me illustrate how to cite a scientific quote.  Refer to: http://docs.google.com/viewer?a=v&q=cache:GZ7jcY8rinUJ:medind.nic.in/jac/t03/i3/jact03i3p234.pdf+Patel,+Dharmeshkumar+N%3B+Goel,+Ashish%3B+Agarwal,+SB%3B+Garg,+Praveenkumar%3B+Lakhani,+Krishna+K+%282003&hl=en&gl=us&pid=bl&srcid=ADGEESi0EspwNsX6RYofhkF28qziMiq4_GQLiSJ_L8giNKUbmXR5JwEglxw85da4jusKiKrA8Kh-KRYiJBI6jk5KNjLzfV-fL7rNt7HVw6BdxKAJS_8rEGbVMox_HsN62D4xccNm_88h&sig=AHIEtbTBrTJwCOW9B1OzmfKWkXUDKWv4pQ
> 
> Specifically, please refer to the "Clinical Features" subsection which states, "100% oxygen can be tolerated at sea level for about 24 - 48 hours without any serious tissue damage.  There is mild carinal irritation on deep inspiration after 3 - 6 hours of exposure of 2 ATA oxygen . . . [however] in the majority of patients, these symptoms subside 4 hours after cessation of exposure."
> 
> When my EMS instructor and preceptor explained the merit of oxygen therapy, it was done so with scientific reasoning, which, though I have asked for, I have not seen despite reading multiple threads on this and other sites regarding this topic.  I am very confident in my assessment, and I am not going to withhold a therapy mandated by my local protocols, my Medical Director, and my medical knowledge which is further enforced by both the AAOS and Brady Pre-Hospital Care texts as well as the aforementioned study, unless someone here cites some sort of scientific evidence that suggests I do so.  Please, if you know something I don't, let me in on it.  However, if you do not, don't espouse the benefits of withholding therapies if you can't support your decision to do so.



I had an extensive response typed out, articles cited, the AHA referenced multiple times...it somehow got erased. I will simply say the info is readily available, on this forum, as I type this. Search for "oxygen and CVA", "Oxygen and MI", ect. What you cited isn't a study, it's a review article. That's six years old (which can be an eternity in medicine). It's also one which was seemingly picked to support your position (the definition of confirmation bias). You can't only pick the stuff you like, you've got to search out the stuff that disagrees with you too, then compare the two for relevance.  

Every single set of protocols I have read has something about "clincal judgement" in them. Your protocols are built around the lowest common denominator. So ask yourself, are you that guy? Do you need to follow protocols to the letter because you can't rise above them? I firmly believe most people on this forum are actively trying to better themselves and are not some of the booger eaters I've worked with that needed extremely restrictive protocols. 

Two last points. Be very, very careful trusting the "scientific reasoning" of other EMS providers. Many of them don't have the basic science background to form the type of reasoned arguments that won't be cut down in 30 seconds by anyone who knows better. Among other EMS providers their arguments may fly, but get them around nurses, RTs and physicians and it becomes obvious they have no idea what their talking about. Secondly (and lastly) stop reading EMT-Basic text. Their worthless beyond EMT-Basic class. Seek out chemistry, A&P, nursing and physician level text if you want to learn about medicine.


----------



## addictedforever

usalsfyre said:


> Seek out chemistry, A&P, nursing and physician level text if you want to learn about medicine.



This is exactly the reason I pore over my dad's nursing school textbooks, his medical dictionaries, the drug handbook, etc. To learn all I can about this subject.


----------



## Handsome Rob

18G said:


> Actually... the reason I didn't spell out the research was because it has already been stated numerous times before on the forum AND I was in the middle of doing something else which didn't permit me to type a long reply with the research.
> 
> I don't always have someone hand feed me the information... I look it up for myself so I suggest you do the same.
> 
> I'll at least give you a head start on your research:
> 
> - CVA: AHA recommends mild-moderate CVA patients receive only room air. Evidence suggests better outcomes than when these patients receive oxygen.
> 
> - MI: Research dating back to the 1950's and recently validated in the 2000's show worsened myocardial ischemia, decreased cardiac output, narrowing of the coronary vessels, and no benefit with oxygen administration. Most MI patients are oxygenating just fine systemically. Oxygen administration has been proven to NOT increase oxygen delivery or reduce tissue death on the other side of the coronary occulsion.
> 
> - Neonatal Resuscitation: The NRP program guidelines were changed to reflect neonatal resuscitation to initially begin with room air only. This is something Europe has been doing forever. The US has been about the only one who insisted on using oxygen. Research shows decreased time to first breath, first cry, and overall better outcomes.
> 
> - ROSC: Oxidative damage as a result of the re-perfusion sends cells to their ultimate death and not restoration as you would think. Research here is ongoing but much evidence suggests minimal O2 titrated to saturation above 94%.
> 
> PA protocols specifically address the new evidence regarding oxygen administration and state to TITRATE OXYGEN ADMINISTRATION to patient needs. It is defined as an SpO2 above 94% and NOT high-flow.
> 
> Under neonatal resuscitation protocol it is also further broken down. A neonate does not present with an SpO2 in the typical normal range. If you check their saturation immediately after birth you will see 60% range, 70% range, etc until their body transitions to the extrauterine circulation.
> 
> The reason the SpO2 is broken down is so providers do not administer oxygen unnecessarily to these babies because of the negative effects and that it serves no purpose.
> 
> I have also read research that found COPD patients should have their oxygen saturation titrated to right around their baseline and not 100%. And no... this has nothing to do with that hypoxic drive myth either.
> 
> I spend prob half my time validating what I have been taught. I have even had a ED physician (also a Medical Command physician) along with an RN give me :censored::censored::censored::censored: because I requested orders for captopril (which we carry) in a obvious CHF patient. I asked the doc why I was denied and all he could say was, "generally patients are only on ACE inhibitors for long term use and we don't give them emergently"... I was quite taken back by this response. We carry captopril and evidence suggest much better outcome with early ACE inhibitor use. And not to mention many EMS systems and hospital ED's give early ACE inhibitors for CHF.  They also claimed that no other medic had ever requested orders for captopril.
> 
> You need to take the lead and find out for yourself. Don't play follow the leader and believe everything your textbook says. It's unfortunate the textbook still teaches what it does about oxygen.




First off, allow me to clarify. I completely agree with telling someone to "look it up" as this builds retention. I am not a proponent of spoon-feeding anyone anything. I, for one, did not state that anyone was wrong, or that the textbooks were right. I completely agree that they are built for the lowest common denominator and inadequate at best. I was upset that people were telling these basics to leave behind what they were taught and do "X" instead. What frightens me is that will most likely say "okay! I learned something!!!" when in reality they have no idea what they are talking about and will now go about withholding O2 because they think they know something about anything. The way you handled it in this post is perfect: "start here." THAT is how a basic, or anyone for that matter can learn. Have you tried navigating these forums? It can be a pain, and while I condone hard work, I do not believe that gaining access to education should be a rite of passage. 



18G said:


> Oh, and really the only reason EMT textbooks are saying 100% for everyone is because the curriculum does not adequately teach Basics how to assess a patients oxygenation status. So it's a empirical blanket treatment with no evidence to support it.



Agreed 100% on the whole of texts available. 



usalsfyre said:


> Did it ever occur to you that in telling you to look up the answer, you might learn and retain the information more readily than having it spoon-fed to you?
> 
> I'm well versed on the hows and whys. I got that way through my own research. Perhaps you should try the same.



Yes. That has occured to me. When I was 6 and my father taught me that lesson. He also handed me a dictionary and a paramedic textbook (read: tools to find the information). I was not saying to spoon feed, I WAS saying that "Google It" is a lame a** response. I have gotten to where I am on my own as well and if I do not know the answer then I know a way to find it. I am unwilling to stake the lives of patient's abroad on the fact that unless a care provider is as versed as I am on the how's and why's then screw em', let em find out on their own. When I could at least point them in the right direction (read: search this forum for oxygen and MI, CVA, etc.)


----------



## mintygood

For everyone here who thinks that every patient should get 15l/m NRB needs to check out some of Dr. Bryan Bledsoe's publications.  He extensively cites how O2 can be harmful in an *EMS* context.


Edit: Lets grow up and recognize that EMT-B class is retardedly easy and is geared for people fresh out of highschool.  What is easier: 1) O2 everyone because it doesn't hurt MOST patients or 2) explain in great detail which patients are harmed by high concentration O2, teach EMT-B's to recognize these pts, and explain why it can be harmful.

1 is easier and MOST pts are kept out of harms way when the majority of 911 trucks are ALS.

People, just because the textbook says it doesn't mean it's the indisputable truth.  Open your mind, do some research, and, for god's sake, take some pride in providing quality pt care.


----------



## usalsfyre

Handsome Rob said:


> Yes. That has occured to me. When I was 6 and my father taught me that lesson. He also handed me a dictionary and a paramedic textbook (read: tools to find the information). I was not saying to spoon feed, I WAS saying that "Google It" is a lame a** response. I have gotten to where I am on my own as well and if I do not know the answer then I know a way to find it. I am unwilling to stake the lives of patient's abroad on the fact that unless a care provider is as versed as I am on the how's and why's then screw em', let em find out on their own. When I could at least point them in the right direction (read: search this forum for oxygen and MI, CVA, etc.)



Ok, I do want to appolgize, I came off more ****ish in my post than I intended. Your absolotely about pointing people in the right direction. What got my ire up in your post was the implication that most on here either didn't know what they were talking about or were lazy. Which is not the case from what I've seen. Arrogant? Sure. Convinced that we are ABSOLOUTLELY right? At times. Lazy and stupid? Not at all. Newbies have been pointed in the right direction over and over again. Some have listened. Others refuse to and leave. Forgive me personally if I get a little fatigued of arguments like this at times. Like I said, went more nuclear than need be and feel bad about that now.


----------



## usalsfyre

mintygood said:


> For everyone here who thinks that every patient should get 15l/m NRB needs to check out some of Dr. Bryan Bledsoe's publications.  He extensively cites how O2 can be harmful in an *EMS* context.



Dr Bledsoe is a heretic who blasphemes against the true faith in EMS.....

(which is to say, he's probably a pretty good guy to listen to...)


----------



## mintygood

usalsfyre said:


> Dr Bledsoe is a heretic who blasphemes against the true faith in EMS.....
> 
> (which is to say, he's probably a pretty good guy to listen to...)



He is one of the few that calls out all of the BS and superstition in EMS.  So say we all.


----------



## flyfisher151

So...my EMT training is BS...?.My textbooks are all lies? Dont give anybody    O2? Dont use the BVM? Dont use EPI? All I'm being taught is worthless? The inspiration is infinite here. See ya in the trenches. 
Great thought provoking discussion! Guess I will be signing up for some more classes after my worthless basic class. I understand that this is a life long, ever changing environment, but where are we supposed to start? EMT-B seemed like a good place. I do plan on continuing my education. I have noticed a lot of animosity amongst the different ranks here. It is helping me start to get a grasp on some basic concepts. Keep battling it out! It helps me look at other angles I might not have thought of before I actually get a patient before me I have to help make it to the ER. 
THANKS for all the comments positive and negative.

PS I do realize that most "basic" courses are exactly that. And, I also realize that the actual learnig takes place in the field and from some mentors whether it be another Basic with 20 years experience, a competent Medic, RN, RT, MD etc. Looking forward to learning a tid bit from all of you as well!


----------



## 18G

EMT training isn't all BS but it is limited and not as capable as some make it out to be. 

Yes, I am a Paramedic now but have spent more time as an EMT working for a FD EMS service then a Medic. A large part of my motivation to become a Paramedic was due to my getting tired of the same old thing call after call. Talk to the patient, take vitals, place em on the stretcher, maybe O2, and transport. In the beginning I was sold on the EMT's save lives propaganda and was a hardcore believer. As the years went on I took notice that most of the calls we responded to BLS could have been handled POV with no difference in outcome. 

Asking a patient 5000 questions does nothing to address their ailment. Taking vitals does nothing to directly treat a condition. O2 of which we thought was more good than bad is now not so true so as BLS we are doing less of that. Basically, I felt like a taxi ride. And yes, a good assessment is very important but at the BLS level after you do your assessment you have to stop the majority of the times because you don't have the capability to go to the next step which is treatment. Least as a Paramedic we assess and then have some good treatment options to directly make the patient better. 

Don't get me wrong EMT training is important and can make a difference in priority conditions but those are the exception.


----------



## flyfisher151

Great sig line! That pretty much nails it. I will most likely move on education wise ASAP. I see the limitations and doldrums associated with the B status. Gotta start somewhere!


----------



## 18G

flyfisher151 said:


> Great sig line! That pretty much nails it. I will most likely move on education wise ASAP. I see the limitations and doldrums associated with the B status. Gotta start somewhere!



You have a great attitude. And please don't get me wrong, what your learning in Basic is useful and is a good stepping stone. Just don't let it inflate your ego and always strive for higher.


----------



## Handsome Rob

usalsfyre said:


> Ok, I do want to appolgize, I came off more ****ish in my post than I intended. Your absolotely about pointing people in the right direction. What got my ire up in your post was the implication that most on here either didn't know what they were talking about or were lazy. Which is not the case from what I've seen. Arrogant? Sure. Convinced that we are ABSOLOUTLELY right? At times. Lazy and stupid? Not at all. Newbies have been pointed in the right direction over and over again. Some have listened. Others refuse to and leave. Forgive me personally if I get a little fatigued of arguments like this at times. Like I said, went more nuclear than need be and feel bad about that now.



It's all good. What's the forum for if not to get a little sharp knowing that the person, hopefully, can take the heat and respond intelligently. I COMPLETELY understand the frustration with saying the same thing over and over and over and over and..ya get it. 



mintygood said:


> For everyone here who thinks that every patient should get 15l/m NRB needs to check out some of Dr. Bryan Bledsoe's publications.  He extensively cites how O2 can be harmful in an *EMS* context.
> 
> 
> Edit: Lets grow up and recognize that EMT-B class is retardedly easy and is geared for people fresh out of highschool.  What is easier: 1) O2 everyone because it doesn't hurt MOST patients or 2) explain in great detail which patients are harmed by high concentration O2, teach EMT-B's to recognize these pts, and explain why it can be harmful.
> 
> 1 is easier and MOST pts are kept out of harms way when the majority of 911 trucks are ALS.
> 
> People, just because the textbook says it doesn't mean it's the indisputable truth.  Open your mind, do some research, and, for god's sake, take some pride in providing quality pt care.




Agreed 100%!



18G said:


> Least as a Paramedic we assess and then have some good treatment options to directly make the patient better.



._..unless you practice in LA County...lol_


----------



## CAOX3

abckidsmom said:


> I wouldn't call it a panic attack or an allergic reaction.  Sometimes chemical stimuli can trigger a reactive airway, and then the anxiety of that feeling can spin the drama right out of control.
> 
> I believe I could sit here and breathe 44 times a minute, shallowly as if my airway feels tight and burns, and could approximate those vitals.
> 
> I'm not saying you were faking it, or there wasn't an actual problem, just that all of those vital signs can be explained by the hyperventilation, and they don't look like an allergic reaction at all.  It is extremely uncomfortable, and anxiety-provoking to have a reactive airway thing going on, and I would say that the problem was related to something along those lines.



Bingo I had this happen while cleaning a stretcher in the ambulance entrance with the doors closed, I know not to bright, but it was late amd all I could think about was getting to bed.  Couldn't catch my breath, amd them the welts stated on my chest and neck.  They attributed it to some type of chemical reaction.  So now I do all my cleaning outside and have never had another issue and I use the same cleaning supplies.


----------



## NREMTB12

MrBrown said:


> No cardiovascular, respiratory or integumentary symptoms and an increasing blood pressure leads Brown to say this is not anaphylaxis.
> 
> Could have been a panic attack but Brown does not see any sort of stimuli
> 
> Most likely cause is the bleach
> 
> ... and why in the bloody hell where there FOUR IC's at this job?




Seems like you said a chemical reaction almost similar to smoke being inhaled by someone with asthma or other respiratory pathology, just triggers a firestorm.


----------

