# Oxygen



## Mattyirie (Oct 1, 2011)

Did my first ride yesterday as an EMT-B student and in 7 calls, i didn't administer oxygen once. Never felt the need. Every patient was vitally stable with adequate oxygen saturation. With the diagnostic tools available to me, perfusion appeared adequate as well. This goes against the generalization in basic class of "give everyone oxygen...it doesn't hurt" and I think I am OK with it. What is everyone else's opinion...?

Just a little background about me, I've taken a full year of anatomy and physiology and I feel I've grasped the concepts well enough to understand basic homeostatic physiology. I also have basic cell bio, pathophysiology, microbiology and a host of self directed research... BUT no field experience except in the hospital.


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## usafmedic45 (Oct 1, 2011)

Oxygen is only indicated when there is clinically demonstrable hypoxia (either via SpO2 or by overt clinical signs like cyanosis or pallor) or in cases of known or strongly suspected CO toxicity. With the exception of CO toxicity (where 15 L/min or more via a NRB is indicated until you get the patient to a hyperbaric facility), the lowest amount of oxygen necessary to achieve a saturation >90% is all that should be used.

O2 does do harm and it has been shown to worsen clinical outcomes when used inappropriately.


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## NomadicMedic (Oct 1, 2011)

Your eduaction and understanding will help you in the field, but if you don't apply oxygen in your class/testing scenarios, expect to get dinged for it.

Most basic, and sadly, some advanced EMS classes are still taught with the hamfisted "Ug! Mongo put on oxygen" mentality.


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## medichopeful (Oct 1, 2011)

Mattyirie said:


> What is everyone else's opinion...?



My opinion is you used your brain and didn't blindly follow protocols.  You're gonna make an excellent provider!


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## FFEMT427 (Oct 6, 2011)

medichopeful said:


> My opinion is you used your brain and didn't blindly follow protocols.  You're gonna make an excellent provider!



I don't think protocols say anything about using our brains


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## JPINFV (Oct 6, 2011)

FFEMT427 said:


> I don't think protocols say anything about using our brains



In other words, EMS isn't a profession and needs to stop complaining about not getting to eat at the adult table in health care.


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## FFEMT427 (Oct 6, 2011)

JPINFV said:


> In other words, EMS isn't a profession and needs to stop complaining about not getting to eat at the adult table in health care.



LOL sometimes it seems that way


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## STXmedic (Oct 6, 2011)

medichopeful said:


> My opinion is you used your brain and didn't blindly follow protocols.  You're gonna make an excellent provider!



Don't you have to call med control to use that???


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## medichopeful (Oct 6, 2011)

PoeticInjustice said:


> Don't you have to call med control to use that???



Only if you've already used the maximum amount allowed by standing orders! :rofl:


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## MrBrown (Oct 6, 2011)

This stuff does my head in.  I must applaud you for not being another one of the "oxygen can't do any harm" group, you sir are one of the few it seems.  Makes me want to crack people around the bloody head with the oxygen tank, seriously.

Oxygen is only indicated for those who are acutely hypoxic (SpO2 < 95% on RA) the exception being those patients with COPD as they often have chronically low SpO2, lowest I've seen is in the high seventies.

Like with anything, clinical judgement is required; somebody who is blue in the face and struggling to breath but has an SpO2 of 100% clearly needs oxygen, somebody who has an SpO2 of 50% (arbitrary number) but who is pink, speaking in full sentences and well perfused doesn't need oxygen.

Hyperoxaemia/oxygen in supraphysiological amounts is really bad news for the following groups of patients and it's most important that oxygen should not be administered to them unless hypoxic:  premature newborns, neonates, stroke, and myocardial infarction.  The reasoning behind premature newborns, stroke and MIs is that oxygen in supraphysiological amounts causes small capilaries and arterioles to constrict which will reduce blood supply, for newborns I am told there is "some evidence" (none I have personally reviewed) that oxygen makes outcomes worse.


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## ArcticKat (Oct 6, 2011)

The problem with education is that there is the School's way of doing things, then there is the real world way.  Do it the way the school wants you to until you graduate...then you can treat your patients properly after that.


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## the_negro_puppy (Oct 6, 2011)

I've even noticed a trend now with my service over the past 2 years of less and less oxygen being used. It used to be that everyone with active chest pain received NRB @ 15 l/m


Now we just titrate oxygen when it is needed. I.E acutely hypoxic/hypoxemic cardiogenic APO patients obviously get maximum oxygen, but a patient with nil DIB/shortness of breath maintaining good sats, clolour etc wont get any.


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## BlakeFabian (Oct 16, 2011)

Yes, O2 is normally withheld until indicated. However, I don't completely agree with that. If you have a Pt who's in pain, dyspnoeic, or with any other complaint than you need to do something; anything.  Simply putting them in your truck & monitoring vitals en-route isn't sufficient.

I almost always tell my Pt's something like, "Sir, I'm going to give you a little bit of Oxygen; not because you're in any kind of respiratory distress but because sometimes the Oxygen helps to diminish (pain, dyspnea, anxiety, etc...)

If that Pt believes that the 02 will help them then, in their mind, it's going to. Even if it doesn't relieve any actual symptoms, their mind tends to focus less on whatever complaint they have because they believe that your intervention is helping them.

On that note, NEVER say that (Insert intervention here) is GOING to help because, when it doesn’t; you’ll become a liar and lose the Pts trust & confidence.


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## JPINFV (Oct 16, 2011)

BlakeFabian said:


> Yes, O2 is normally withheld until indicated. However, I don't completely agree with that. If you have a Pt who's in pain, dyspnoeic, or with any other complaint than you need to do something; anything.  Simply putting them in your truck & monitoring vitals en-route isn't sufficient.



Dyspnoeic is an indication of respiratory illness. Supplemental oxygen is appropriate, albeit a NRB is not necessarily required. 

Patients who are in pain need pain medication, not magical air. 

Patients with complaints need their complaints appropriately treated, which is not giving them magical air. 

Why do you need to do anything? Benign neglect is completely appropriate in a lot of cases, especially when it comes to providing magical air and nothing else. If something must be done, why not give adenosine, or lidocaine, or naloxone, or any other drug. What makes the drug known as oxygen any more or less of a drug than lidocaine or naloxone or adenosine? Why do those drugs have indications that are more complicated than "give if ambulance is present"?

How are providers smart enough to know when to transport with lights and sirens, or when to give adenosine or lidocaine, or naloxone, but at the same time too incompetent to determine when to give supplemental oxygen? 



> I almost always tell my Pt's something like, "Sir, I'm going to give you a little bit of Oxygen; not because you're in any kind of respiratory distress but because sometimes the Oxygen helps to diminish (pain, dyspnea, anxiety, etc...)



Does the oxygen do it, or is it a placebo? Would sugar pills provide the same effect, and if so, why not just administer a sugar pill? It's cheaper. 


> If that Pt believes that the 02 will help them then, in their mind, it's going to. Even if it doesn't relieve any actual symptoms, their mind tends to focus less on whatever complaint they have because they believe that your intervention is helping them.



So if the patient thinks naloxone or adenosine or lidocaine will help them, will give them those drugs on command?

Does the patient believe supplemental oxygen will help them on their own accord, or do they believe so because you lied to them about it? 



> On that note, NEVER say that (Insert intervention here) is GOING to help because, when it doesn’t; you’ll become a liar and lose the Pts trust & confidence.



Why are you administering medications when you don't have enough confidence that the intervention is appropriate to tell them that it will work?


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## CAOX3 (Oct 16, 2011)

BlakeFabian said:


> Simply putting them in your truck & monitoring vitals en-route isn't sufficient.



If its all that they require, thats what they recieve.

I dont need to look busy to justify my existence, if all they require is a ride then thats what they get.


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## daj72 (Oct 16, 2011)

MrBrown said:


> Hyperoxaemia/oxygen in supraphysiological amounts is really bad news for the following groups of patients and it's most important that oxygen should not be administered to them unless hypoxic:  premature newborns, neonates, stroke, and myocardial infarction.  The reasoning behind premature newborns, stroke and MIs is that oxygen in supraphysiological amounts causes small capilaries and arterioles to constrict which will reduce blood supply, for newborns I am told there is "some evidence" (none I have personally reviewed) that oxygen makes outcomes worse.



Perhaps a stupid question, MrBrown, but evidence for the negativ supraphysiological effect is it available online ?


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## BlakeFabian (Oct 16, 2011)

JPINFV said:


> Dyspnoeic is an indication of respiratory illness. Supplemental oxygen is appropriate, albeit a NRB is not necessarily required.
> 
> Patients who are in pain need pain medication, not magical air.
> 
> Patients with complaints need their complaints appropriately treated, which is not giving them magical air.



I agree, and if I was putting across the motion of only providing O2 then I apologize. Of course, when 02 or another intervention is indicated then provide it. I was simply stating my opinion of what to do when there really aren’t any indicated interventions.



JPINFV said:


> Why do you need to do anything? Benign neglect is completely appropriate in a lot of cases, especially when it comes to providing magical air and nothing else. If something must be done, why not give adenosine, or lidocaine, or naloxone, or any other drug. What makes the drug known as oxygen any more or less of a drug than lidocaine or naloxone or adenosine? Why do those drugs have indications that are more complicated than "give if ambulance is present"?



Simply transporting is completely appropriate when indicated. If that's all you want to do; go for it. In my opinion, It's better to always be doing something while in the back with your Pt instead of sitting still and merely checking vitals every 15 minutes.

This is the BLS section of the forum, so I'm assuming the poster would be on a BLS truck. Likewise, on a BLS truck the medications wouldn't be available unless tandem is called.



JPINFV said:


> How are providers smart enough to know when to transport with lights and sirens, or when to give adenosine or lidocaine, or naloxone, but at the same time too incompetent to determine when to give supplemental oxygen?



You're misinterpreting what I'm trying to say.




JPINFV said:


> Does the oxygen do it, or is it a placebo? Would sugar pills provide the same effect, and if so, why not just administer a sugar pill? It's cheaper.



Good idea. I'm simply saying, in my opinion, doing something is better than nothing.



JPINFV said:


> So if the patient thinks naloxone or adenosine or lidocaine will help them, will give them those drugs on command?



Of course not. I stated O2 because it's a intervention with no side effects in low doses (In a normal, no interventions indicated patient.)



JPINFV said:


> Does the patient believe supplemental oxygen will help them on their own accord, or do they believe so because you lied to them about it?



It's situation dependent. Sometimes the simple act of the BLS provider providing an intervention may convince the Pt that it's helping.

Sometimes, it's because of the white lie.



JPINFV said:


> Why are you administering medications when you don't have enough confidence that the intervention is appropriate to tell them that it will work?



Because that's what I was taught. It's not because I lack confidence in my interventions; it’s because there's always those situations where your intervention won't have its anticipated effect on the Pt.

I was taught to never make promises in EMS. Saying “this WILL work” is a promise; Murphy’s Law is then begging to make that technician look like a fool.

Keep in mind, the original poster asked for our opinions. My entire posts are of my own opinions. I'm not saying it's the absolute best thing to do, I'm saying it what I think is right. If you disagree, then simply don't do what I do. 

I've cared for my Pts this way for the last 2 years, and neither my director nor medical director have told me to stop.


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## fast65 (Oct 16, 2011)

BlakeFabian said:


> I agree, and if I was putting across the motion of only providing O2 then I apologize. Of course, when 02 or another intervention is indicated then provide it. I was simply stating my opinion of what to do when there really aren’t any indicated interventions.
> 
> 
> 
> ...



So what I'm gathering from your post is that you're going to give a drug that's not indicated, just because there's nothing else to do? If there's "no intervention indicated" then why are you providing oxygen, which is in fact an intervention?

It's not ok to lie to our patients and instill the belief that a little oxygen will solve their problems, like JPINFV said, it's not some magical drug. Lying to our patients reflects poorly on our profession, and it reflects poorly on the provider, I don't care how minor of a lie it is.

Believe it or not, not every patient we run across requires an intervention during transport. Some just require a thorough assessment and a monitoring of vital signs, no use providing a drug that they don't need just because you feel obligated to do something more. Providing oxygen when it's not indicated just because someone called 911 is a close-minded action and as such it gives me the impression that the provider lacks judgement and logical thinking. My $0.02.


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## JPINFV (Oct 16, 2011)

BlakeFabian said:


> Simply transporting is completely appropriate when indicated. If that's all you want to do; go for it. In my opinion, It's better to always be doing something while in the back with your Pt instead of sitting still and merely checking vitals every 15 minutes.



When you see your physician for a checkup, do you expect to be prescribed something even if no medication is indicated?


> This is the BLS section of the forum, so I'm assuming the poster would be on a BLS truck. Likewise, on a BLS truck the medications wouldn't be available unless tandem is called.


Ok, why not insert a NPA or administer oral glucose or administer activated charcoal? 




> Good idea. I'm simply saying, in my opinion, doing something is better than nothing.


Why is doing something better than nothing? Since plenty of systems and services charge extra for the administration of oxygen, is causing the patient to have a larger bill (sometimes significantly larger (.pdf warnng)) worth the provider being able to say, "At least I did something"?



> Of course not. I stated O2 because it's a intervention with no side effects in low doses (In a normal, no interventions indicated patient.)


Naloxone isn't going to cause side effects in a patient where it isn't contraindicated and in low doses. 

However, let's switch back to EMT level interventions. NPAs don't have any major side effects when placed properly, and if the patient gags, it's easily reversible. Oral glucose and activated charcoal doesn't have any side effects in the doses administered if no contraindication is present. Why not administer those as well? 

Why should the side effect profile matter when a drug is not indicated? The side effect of nothing (when indicated) is... wait for it... nothing. 




> It's situation dependent. Sometimes the simple act of the BLS provider providing an intervention may convince the Pt that it's helping.
> 
> Sometimes, it's because of the white lie.


Samuel Hahnemann would be proud. 



> Because that's what I was taught. It's not because I lack confidence in my interventions; it’s because there's always those situations where your intervention won't have its anticipated effect on the Pt.
> 
> I was taught to never make promises in EMS. Saying “this WILL work” is a promise; Murphy’s Law is then begging to make that technician look like a fool.


Fine, hedge the bet with "this should work." Of course saying "oxygen should help" when oxygen isn't indicated is a white lie. A white lie that could add to your patient's bill. 


> Keep in mind, the original poster asked for our opinions. My entire posts are of my own opinions. I'm not saying it's the absolute best thing to do, I'm saying it what I think is right. If you disagree, then simply don't do what I do.


It's not much of a discussion board if no discussion occurs. Why should *any* opinion, *including mine*, stand unchallenged if another poster sees reason to challenge it? I am neither infallible, nor afraid of defending my opinion, nor afraid of stating that I'm wrong when I'm wrong. By stating that this is simply your opinion in this manner, what are you afraid of?



> I've cared for my Pts this way for the last 2 years, and neither my director nor medical director have told me to stop.


Ask your physician if he administers oxygen for no reason other than he hasn't thought of anything else to do in a patient where supplemental oxygen is not indicated. If he's not afraid of having his patients sit in the ED without supplemental oxygen while waiting for him to initiate treatment (for example, between being brought back and his exam, between his exam and the return of any laboratory tests, or any other delay), than what is EMS afraid of?

How often do you take a patient to the ED on supplemental oxygen only for the receiving RN discontinue oxygen therapy? If a continuous treatment is suddenly discontinued simply because there no longer is a "positive ambulance sign," then shouldn't that be an indication that something is deficient?

I'll end on this note. The absolute worst I've ever felt after handing over a patient to an RN on an emergency call was a patient where I justified placing an NRB because of "protocol." Why did I feel terrible about that?

...because I should be better than that. 

EMS should be better than that. 

We should be able to, and expected to, defend our interventions, regardless of how minor, based on the patient's condition and the results of our exam. By being unable to justify my intervention, I failed my patient that day. I failed EMS that day. I failed myself that day. Sure, I've had the entire, "Must complete exam before transporting priority patient down the street to the ED" tunnel vision patient, which no doubt had the potential to cause much greater harm than simply administering oxygen when it isn't indicated. However a rookie mistake and a consciously failing to think are two drastically different issues. A rookie mistake is much different to me than saying, "I administered a treatment that I could not justify." 

The kicker? The RN didn't say anything negative to me either.


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## BlakeFabian (Oct 16, 2011)

You both make valid points.

Let's just agree to disagree.


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## fast65 (Oct 16, 2011)

BlakeFabian said:


> You both make valid points.
> 
> Let's just agree to disagree.



The end to yet another discussion


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## Tigger (Oct 16, 2011)

BlakeFabian said:


> Yes, O2 is normally withheld until indicated. However, I don't completely agree with that. If you have a Pt who's in pain, dyspnoeic, or with any other complaint than you need to do something; anything.  Simply putting them in your truck & monitoring vitals en-route isn't sufficient.



No, putting them in your truck and transporting without 02 is sufficient, provided that a thorough assessment has been completed and the patient is no respiratory distress. Oxygen is not harmless, I don't care if that's how someone has been trained, it is not proper patient care to provide a medication that is not indicated. As a basic working on a BLS truck, I'll be the first to remark that it sucks to have a patient in pain and be unable to do anything but transport in a position of comfort. But at my present level of training, I have no other options.



> I almost always tell my Pt's something like, "Sir, I'm going to give you a little bit of Oxygen; not because you're in any kind of respiratory distress but because sometimes the Oxygen helps to diminish (pain, dyspnea, anxiety, etc...)
> 
> If that Pt believes that the 02 will help them then, in their mind, it's going to. Even if it doesn't relieve any actual symptoms, their mind tends to focus less on whatever complaint they have because they believe that your intervention is helping them.



So you're lying to your patients then? That is violating the trust of your patient, whether they aware of it or not. Oxygen in itself does not reduce pain or anxiety in itself. Being in the care of a professional care giver might help reduce perceived pain levels or anxiety, but oxygen will not.



> On that note, NEVER say that (Insert intervention here) is GOING to help because, when it doesn’t; you’ll become a liar and lose the Pts trust & confidence.



Speaking of becoming a liar and losing the patients trust...


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## usalsfyre (Oct 16, 2011)

BlakeFabian said:


> You both make valid points.
> 
> Let's just agree to disagree.


The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.


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## fast65 (Oct 16, 2011)

usalsfyre said:


> The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.



I will agree with your disagreeing to his agreeing to disagree.


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## Tigger (Oct 16, 2011)

usalsfyre said:


> The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.



+1. If you post something, you better be able to defend it. If this discussion was between you and your medical director (which it is clearly not), would the "agree to disagree and walk away option" exist? No of course not. If you can't rationalize and defend your treatment, you need to reconsider what you're doing to your patient.

As the fat man says, "doing nothing is doing something." 


Sent from my out of area communications device.


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## JPINFV (Oct 16, 2011)

Tigger said:


> As the fat man says, "doing nothing is doing something."



Rule 13: The delivery of good medical care is to do as much nothing possible.


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## abckidsmom (Oct 16, 2011)

fast65 said:


> I will agree with your disagreeing to his agreeing to disagree.



I agree with your agreeing with his disagreeing with his agreeing to disagree.


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## JPINFV (Oct 16, 2011)

abckidsmom said:


> I agree with your agreeing with his disagreeing with his agreeing to disagree.



I disagree to disagree with your agreeing with his agreeing with his disagreeing with his agreeing to disagree.


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## fast65 (Oct 16, 2011)

JPINFV said:


> I disagree to disagree with your agreeing with his agreeing with his disagreeing with his agreeing to disagree.


I agree to your disagreeing to disagree with her agreeing with my agreeing with his disagreeing with his agreeing to disagree


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## Chief Complaint (Oct 16, 2011)

Hah.  You guys are giving me a headache...

Im gonna put on my NRB and crank it up until it goes away.


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## CAOX3 (Oct 16, 2011)

Chief Complaint said:


> Hah.  You guys are giving me a headache...
> 
> Im gonna put on my NRB and crank it up until it goes away.




We actually administer oxygen to patients with migraines/cluster headaches with great sucess.


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## EMTswag (Oct 20, 2011)

MrBrown said:


> This stuff does my head in.  I must applaud you for not being another one of the "oxygen can't do any harm" group, you sir are one of the few it seems.  Makes me want to crack people around the bloody head with the oxygen tank, seriously.
> 
> Oxygen is only indicated for those who are acutely hypoxic (SpO2 < 95% on RA) the exception being those patients with COPD as they often have chronically low SpO2, lowest I've seen is in the high seventies.
> 
> ...



Now, are you against o2 on the suspected MI all together or are you against high flow o2 on the suspected MI?


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## JPINFV (Oct 20, 2011)

EMTswag said:


> Now, are you against o2 on the suspected MI all together or are you against high flow o2 on the suspected MI?




I'm against O2 in patients who are neither hypoxic nor in respiratory distress. Ischemia and hypoxia is not the same thing.


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## Sasha (Oct 20, 2011)

If the problem is a blockage you can put them on 30lpm you're still not going to get oxygen to the ischemic tissue. 

Sent from LuLu using Tapatalk


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## EMTswag (Oct 20, 2011)

JPINFV said:


> I'm against O2 in patients who are neither hypoxic nor in respiratory distress. Ischemia and hypoxia is not the same thing.



Okay yeah just clarifying I happen to agree with you. As it happens though a lot of times, as you undoubtedly know, an MI or even any sort of chest pain has some associated SOB that would be treatable, not necessarily with 15lpm, but some application of o2. 

Then again, I've brought many a patient into the ER with chest pains and no associated SOB and gotten questioned as to why my pt wasn't on o2. 

On a related note, I had a partner put a pt with back pain secondary to a minor fall on 15 lpm nrb... :glare:


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## cad2830 (Nov 7, 2011)

usalsfyre said:


> The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.



I disagree with that. Because I was "taught that way"  is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps. 



			
				NYS BLS PROTOCOL M-17 (Suspected Stroke) said:
			
		

> I. Perform initial assessment.
> II. Assure that the patient’s airway is open and that breathing and circulation are adequate.
> *III. Administer high concentration oxygen, suction as necessary, and be prepared to assist ventilations.*
> IV. Position patient with head and chest elevated or position of comfort, unless doing so
> ...


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## fast65 (Nov 7, 2011)

cad2830 said:


> I disagree with that. Because I was "taught that way"  is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.




Sorry, that's just a terrible excuse. If you want to be taken seriously by your peers you need to use something called "clinical judgement". Applying oxygen just because the protocol says to is not an example of that.


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## Akulahawk (Nov 7, 2011)

cad2830 said:


> I disagree with that. Because I was "taught that way"  is a good reason. I was taught to my local protocols. *The protocols were developed by people that have far more experience and knowledge than I do.* Virtually all of our protocols have O2 in the first couple of steps.


Your protocols were developed by people that have more experience and knowledge that you do... for those providers that are barely at the 8th grade reading level - and don't want to improve that. Think lowest common denominator... many providers are WELL above that and could apply good judgment. 


fast65 said:


> Sorry, that's just a terrible excuse. If you want to be taken seriously by your peers you need to use something called "clinical judgement". Applying oxygen just because the protocol says to is not an example of that.


And I agree (and will go further than that) that "because that's what I was taught and my protocols say so" makes for worse than terrible clinical judgment. It's NO clinical judgment. That's "cookbook medicine". While your protocols generally _must_ be followed to the letter, good clinical judgment may involve selecting several different protocols to run simultaneously on your patient. Good clinical judgment may mean having to place your patient on a high concentration of O2 _knowing_ that current best practices indicate that low flow or _no flow_ is properly indicated and doing what you must do to keep your certificate/license... and relaying to the receiving medical team that you had to apply oxygen to that patient per protocol and you believe that your patient doesn't need greater than room air concentrations. 

If I'm following a specific protocol, it's because I have evaluated the patient, determined what's wrong within my knowledge base, and determined that a specific protocol would best fit the patient's problem at the moment... and that I don't need to call for a base to get an order to implement a different plan (not in the "book") or modify an existing protocol to fit the issue at the moment. 

Just following the book blindly is not using good clinical judgment... a robot could do that. EMS providers are human, and not robots, because we can _think._


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## Aprz (Nov 7, 2011)

Some protocols have a disclaimer saying that they are just guideline, and to use sound judgement when you can. That's what it is like where I live.


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## Tigger (Nov 7, 2011)

cad2830 said:


> I disagree with that. Because I was "taught that way"  is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.



No, that is an awful reason to do anything, especially medicine. Note that the protocols you posted include the verbiage "as necessary." That gives you some leeway to make clinical decision making. If oxygen is not indicated, why would you give it? 

If gluctose was not indicated would you still give it? There aren't really any serious effects....

If you're on BLS truck and you have a sick patient, sometimes there are no interventions available for you. Welcome to being a low-level provider, where sometimes your best treatment is blankets, pillows, and holding someone's hands. And calling for medics or getting to the hospital without delay. 

Doing "nothing" is the right thing to do if the only tools at your disposal also do nothing for your patient.


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## JPINFV (Nov 7, 2011)

cad2830 said:


> I disagree with that. Because I was "taught that way"  is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.



Sure. Now just never make an argument that EMS is a profession.


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## paradoqs (Nov 11, 2011)

In my district, high fkow O2 is indicated for any suspected cardiac chest pain. Now, if my medical director wanted me to use clinical judgement, why didnt he put something in there about checking the pt's o2 sats/oxygenation before administering o2?  I think alot of the issue derives from the old theory that oxygen will never hurt and once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change. 
   On another note, I had an ed rn freak out on me because i didnt take a bgl on a pt that was aaox3 with no diabetic hx and a c/c of abnormal labs. I told her a bgl wasnt indicated and my captain agreed with me later. She still expected a bgl though. I think if I bring her a pt with cardiac c/p who is satting fine and on no oxygen, she might try to take my head off.


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## Tigger (Nov 11, 2011)

paradoqs said:


> In my district, high fkow O2 is indicated for any suspected cardiac chest pain. Now, if my medical director wanted me to use clinical judgement, why didnt he put something in there about checking the pt's o2 sats/oxygenation before administering o2?  I think alot of the issue derives from the old theory that oxygen will never hurt and once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change.
> On another note, I had an ed rn freak out on me because i didnt take a bgl on a pt that was aaox3 with no diabetic hx and a c/c of abnormal labs. I told her a bgl wasnt indicated and my captain agreed with me later. She still expected a bgl though. I think if I bring her a pt with cardiac c/p who is satting fine and on no oxygen, she might try to take my head off.



So stand up tall and tell her you practice evidence based medicine. Don't be pushed around on patient care. What's the worst that happens, you get called in front of your medical director (unlikely) and then you have a discussion with the net result of him agreeing with you. If you are providing excellent care you have nothing to be afraid of.


Sent from my out of area communications device.


----------



## Handsome Robb (Nov 11, 2011)

BGL is a standard vital sign for us. With that said if we don't start a line we usually won't get a BGL off them seeing as most cheat and snag our sample off the IV needle. Don't jump down my throat for CBG vs. VBG I know the difference.

With that said, there are more and more studies showing the detrimental effects of hyperoxygenation in cardiac patients. I wonder how long it will take for protocol based practices to catch on.


----------



## paradoqs (Nov 12, 2011)

NVRob said:


> BGL is a standard vital sign for us. With that said if we don't start a line we usually won't get a BGL off them seeing as most cheat and snag our sample off the IV needle. Don't jump down my throat for CBG vs. VBG I know the difference.



I dont know the difference. Do you mean venous vs capilary? Please explain


----------



## Handsome Robb (Nov 12, 2011)

paradoqs said:


> I dont know the difference. Do you mean venous vs capilary? Please explain



Yes venous vs. capillary. Depending on what your glucometer is calibrated the reading may be off if you use a sample from the wrong source whether it be venous samples or capillary samples, venous usually being higher than capillary if I remember correctly.


----------



## paradoqs (Nov 12, 2011)

NVRob said:


> Yes venous vs. capillary. Depending on what your glucometer is calibrated the reading may be off if you use a sample from the wrong source whether it be venous samples or capillary samples, venous usually being higher than capillary if I remember correctly.



We use either and dont differentiate between the two regarding the value.


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## usalsfyre (Nov 12, 2011)

paradoqs said:


> In my district, high fkow O2 is indicated for any suspected cardiac chest pain.


Just a quick word, it's not indicated no matter what district your in. It's just in your protocols.



paradoqs said:


> Now, if my medical director wanted me to use clinical judgement, why didnt he put something in there about checking the pt's o2 sats/oxygenation before administering o2?


Honestly? Because likely he doesn't trust his providers medical judgement.  



paradoqs said:


> I think alot of the issue derives from the old theory that oxygen will never hurt and once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change.


Nail on the head. In the meantime though, we need to be LOBBYING to get these protocols changed. 



paradoqs said:


> On another note, I had an ed rn freak out on me because i didnt take a bgl on a pt that was aaox3 with no diabetic hx and a c/c of abnormal labs. I told her a bgl wasnt indicated and my captain agreed with me later. She still expected a bgl though. I think if I bring her a pt with cardiac c/p who is satting fine and on no oxygen, she might try to take my head off.


Just because they're an RN, or for that matter an MD doesn't mean they're a particularly great or up-to-date provider. I've had a "discussion" at bedside with a trauma surgeon before, he thought any analgesia was too much. The discussion ended when the patient told him he appreciated the fentanyl . Hold your ground if you've got the evidence to back it up.


----------



## mint_condition (Nov 18, 2011)

Tigger said:


> Oxygen in itself does not reduce pain or anxiety in itself. Being in the care of a professional care giver might help reduce perceived pain levels or anxiety, but oxygen will not.



maybe its because i work in LA for an non-emergency BLS company, and i've never had a hypoxic pt, but i do pick up a lot of anxious its and pt's in some pain going in as direct admits and i'll put them on 2-4 lpm, and it almost ALWAYS helps the pt's with anxiety. so i dont see what you mean when you say it helps reduce perceived pain or anxiety; when i get to my destination my pt always seems to feel a little better than when i picked them up. as i go along reading this, i find that there are a lot of good points, and a lot of ignorant points. not saying that your point is ignorant Tigger, just saying i've read some. i will never put O2 on a pt. that doesnt have any indication of needing it, but quite a few of my pt's get O2.


----------



## usafmedic45 (Nov 18, 2011)

CAOX3 said:


> We actually administer oxygen to patients with migraines/cluster headaches with great sucess.



Really....any evidence that it actually works? In 16 years, I've never seen it work.


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## usafmedic45 (Nov 18, 2011)

cad2830 said:


> I disagree with that. Because I was "taught that way"  is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.



OK, can we agree that I have been "taught that way" to assume that you lack supratentorial function and apparently couldn't reason your way out of a harvested corn field because you weren't "taught to think that way?" :glare:


----------



## usafmedic45 (Nov 18, 2011)

> but i do pick up a lot of anxious its and pt's in some pain going in as direct admits and i'll put them on 2-4 lpm, and it almost ALWAYS helps the pt's with anxiety


So does talking to them normally.  Oxygen is not indicated for anxiety.  It actually can worsen it.



> i've never had a hypoxic pt





> i will never put O2 on a pt. that doesnt have any indication of needing it, but quite a few of my pt's get O2.



Are you familiar with the phrase "contradiction of terms"?


----------



## usafmedic45 (Nov 18, 2011)

paradoqs said:


> I dont know the difference.



I honestly get the feeling that this is a common occurrence based upon your previous post in this thread.



> once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change.



That happened quite a few years ago.  Time to pull some studies and go make an appointment to talk with your medical director.


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## JPINFV (Nov 18, 2011)

usafmedic45 said:


> That happened quite a few years ago.  Time to pull some studies and go make an appointment to talk with your medical director.



Shouldn't we withhold interventions until the studies shows them to be effective, not give interventions until studies show them to be harmful?


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## usafmedic45 (Nov 18, 2011)

JPINFV said:


> Shouldn't we withhold interventions until the studies shows them to be effective, not give interventions until studies show them to be harmful?



Yes, but remember, this is EMS.  It's all about what the protocols say and not about what is actually beneficial for the patient.


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## mint_condition (Nov 18, 2011)

CAOX3 said:


> We actually administer oxygen to patients with migraines/cluster headaches with great sucess.



My friend has cluster headaches, the doctors prescribed her oxygen, so she has a tank in her room and she throws that on when she feels it come on


----------



## usafmedic45 (Nov 18, 2011)

mint_condition said:


> My friend has cluster headaches, the doctors prescribed her oxygen, so she has a tank in her room and she throws that on when she feels it come on



Once again, I reiterate....does anyone have any evidence that it actually works? I've never seen any research comparing it to a placebo, etc.


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## JPINFV (Nov 18, 2011)

Here are the studies listed in Up-To-Date regarding oxygen and cluster headaches. Not a lot of evidence, but to be honest, my bar for administering medications like oxygen is very low to begin with. 

http://www.ncbi.nlm.nih.gov.proxy.westernu.edu/pubmed?term=19996400
http://www.ncbi.nlm.nih.gov.proxy.westernu.edu/pubmed?term=3885921
http://www.ncbi.nlm.nih.gov.proxy.westernu.edu/pubmed?term=18646121

There was another one, but Pubmed didn't have an abstract for it.


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## usafmedic45 (Nov 18, 2011)

I looked at Pubmed but just saw a lot of subjective studies where the patient reported relief but it didn't seem (at least from the abstracts) that there was a control group.

BTW, the links you gave are restricted because they include the proxy server for your school.


----------



## Aidey (Nov 18, 2011)

usalsfyre said:


> Just because they're an RN, or for that matter an MD doesn't mean they're a particularly great or up-to-date provider.



+1

I just had a discussion with an ED doc about O2 in cardiac patients. Our protocols are now inline with AHA's recommendations, including the ones for O2. However, 9 times out of 10 when we bring the patients in they still get O2. I asked about it and the doc said that he was going to continue to do it becuase he had seen O2 decrease chest pain*, he hadn't seen any good studies indicating that it was harmful for the time they are in the ED, and because we need to try and squeeze though as much O2 as possible. I didn't even bother trying to discuss it further with him. 

* In what world does an ACS patient ever get O2 in isolation? I'm sure it is the O2 doing it and not the nitro, ASA, heparin, palvix, metoprolol, fentanyl or whatever else the patient is getting.


----------



## JPINFV (Nov 18, 2011)

usafmedic45 said:


> I looked at Pubmed but just saw a lot of subjective studies where the patient reported relief but it didn't seem (at least from the abstracts) that there was a control group.
> 
> BTW, the links you gave are restricted because they include the proxy server for your school.


Let's try this again....
http://www.ncbi.nlm.nih.gov/pubmed?term=19996400
http://www.ncbi.nlm.nih.gov/pubmed?term=18646121
http://www.ncbi.nlm.nih.gov/pubmed?term=3885921


----------



## usafmedic45 (Nov 18, 2011)

JPINFV said:


> Let's try this again....
> http://www.ncbi.nlm.nih.gov/pubmed?term=19996400
> http://www.ncbi.nlm.nih.gov/pubmed?term=18646121
> http://www.ncbi.nlm.nih.gov/pubmed?term=3885921



Thanks JP.  I guess I was mistaken.


----------



## Tigger (Nov 18, 2011)

mint_condition said:


> maybe its because i work in LA for an non-emergency BLS company, and i've never had a hypoxic pt, but i do pick up a lot of anxious its and pt's in some pain going in as direct admits and i'll put them on 2-4 lpm, and it almost ALWAYS helps the pt's with anxiety. so i dont see what you mean when you say it helps reduce perceived pain or anxiety; when i get to my destination my pt always seems to feel a little better than when i picked them up. as i go along reading this, i find that there are a lot of good points, and a lot of ignorant points. not saying that your point is ignorant Tigger, just saying i've read some. i will never put O2 on a pt. that doesnt have any indication of needing it, but quite a few of my pt's get O2.



It is not ignorant, despite your ancedotal accounts to the contrary, to say that oxygen *does not help the patient's anxiety level. It doesn't it doesn't it doesn't.* What might be helping is the fact that the patient is comforted by the fact that they are on the way to the hospital and believe they are being cared for by a professional. 

You could give a patient glucose and it might calm them down because they think they're getting some sort of helpful medication. But you don't do that right?


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## J. Burdett (Nov 20, 2011)

MrBrown said:


> Hyperoxaemia/oxygen in supraphysiological amounts is really bad news for the following groups of patients and it's most important that oxygen should not be administered to them unless hypoxic:  premature newborns, neonates, stroke, and myocardial infarction.  The reasoning behind premature newborns, stroke and MIs is that oxygen in supraphysiological amounts causes small capilaries and arterioles to constrict which will reduce blood supply, f*or newborns I am told there is "some evidence" (none I have personally reviewed) that oxygen makes outcomes worse.*



I concur 

Neonates w/ L ventricular hypoplastic syndrome rely on a patent ductus arterious for systemic perfusion most of the time. When given high flow O2 the resulting vasoconstriction closes the PDA which results in death. Which is bad.

So if you get a call for a "blue baby" and find out that the newborn was born outside of the hospital (rural or low income areas mainly) w/ SpO2 in the 60's which gets *worse* w/ high flow O2 this might be something to consider.

Also, due to vasoconstriction, high flow O2 can cause blindness in neonates.


----------



## J. Burdett (Nov 20, 2011)

usafmedic45 said:


> Really....any evidence that it actually works? In 16 years, I've never seen it work.



I have 

46 yo male w/ hx of cluster migraines received 15lpm NRB and was asymptomatic before our arrival at the ER. Pretty simple physiology behind why it's therapeutic.


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## usalsfyre (Nov 20, 2011)

J. Burdett said:


> I have
> 
> 46 yo male w/ hx of cluster migraines received 15lpm NRB and was asymptomatic before our arrival at the ER. Pretty simple physiology behind why it's therapeutic.



N=1

Cluster headaches tend to be self limiting anyway


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## usafmedic45 (Nov 20, 2011)

> When given high flow O2 the resulting vasoconstriction closes the PDA which results in death. Which is bad.



It doesn't always result in death so you could phrase that better.  It worsens the clinical condition and death is a rare occurrence.



> Neonates w/ L ventricular hypoplastic syndrome



You know that that's not the only condition where this is a factor correct?  Also, it's called hypoplastic left heart syndrome since very seldom is the ventricle the only structure affected.  Usually the aorta and the valves on the left side of the heart (mitral and aortic) are also effected.


> I have
> 
> 46 yo male w/ hx of cluster migraines received 15lpm NRB and was asymptomatic before our arrival at the ER. Pretty simple physiology behind why it's therapeutic.



I said 'evidence' not a testimonial.



> So if you get a call for a "blue baby" and find out that the newborn was born outside of the hospital (rural or low income areas mainly) w/ SpO2 in the 60's which gets worse w/ high flow O2 this might be something to consider.



Actually the SpO2 can rise or stay the same (at least initially), but the clinical condition deteriorates and THEN the SpO2 may plummet.  



> Also, due to vasoconstriction, high flow O2 can cause blindness in neonates.



Once again, it's a rare complication and is normally only seen in extremely long term O2 use.  It's not something we should be all that concerned about in the field.  By the way, O2 is only a risk factor for the condition (retinopathy of prematurity), not a direct cause of it.  Hypoxia is also a risk factor for it since it's most likely due to a complicated mix of issues which result in a fibrovascular proliferation of the retinae. Saying it's due to O2 therapy is a bit like saying that being a member of EMTLife predisposes one to being an EMT.  It doesn't mean that one is or will become one, but there is a strong correlation with it.  Understood?

Your posts on this thread tend to serve as a perfect example of why a little bit of knowledge on a topic can be a very dangerous thing.


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## AmeriMedic21 (Nov 21, 2011)

yeah, its not always needed on everybody, but here is what i do. Sometimes i have those pts that are anxious, and when you sell oxygen in a sense that it will "make them feel better", and you apply it, they miraciously feel better, its kind of like the placebo effect i guess. I know what you mean though, my partner puts it on everybody, and i can sometimes get selective, considering im the only one who changes the big 02 tank on our truck. lol


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## Tigger (Nov 21, 2011)

AmeriMedic21 said:


> yeah, its not always needed on everybody, but here is what i do. Sometimes i have those pts that are anxious, and when you sell oxygen in a sense that it will "make them feel better", and you apply it, they miraciously feel better, its kind of like the placebo effect i guess. I know what you mean though, my partner puts it on everybody, and i can sometimes get selective, considering im the only one who changes the big 02 tank on our truck. lol



Why not give them glucose then? It's lighter and easier to restock than 02.


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## J. Burdett (Nov 22, 2011)

usafmedic45 said:


> It doesn't always result in death so you could phrase that better.  It worsens the clinical condition and death is a rare occurrence.
> 
> *I've seen it cause death but yes, you are correct, it does not always cause death. I was merely stating the severity of doing such. Try not to be so literal*
> 
> ...


............


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## patzyboi (Dec 19, 2012)

usafmedic45 said:


> Oxygen is only indicated when there is clinically demonstrable hypoxia (either via SpO2 or by overt clinical signs like cyanosis or pallor) or in cases of known or strongly suspected CO toxicity. With the exception of CO toxicity (where 15 L/min or more via a NRB is indicated until you get the patient to a hyperbaric facility), the lowest amount of oxygen necessary to achieve a saturation >90% is all that should be used.
> 
> O2 does do harm and it has been shown to worsen clinical outcomes when used inappropriately.



Can you elaborate on the harm part here? I know COPD patients administering low amounts of oxygen over a period of time is ideal, but you shoudnt even withhold O2 if they are hypoxic


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## VFlutter (Dec 19, 2012)

What a Gem of a thread. Thanks for bringing it back from the dead


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## CANDawg (Dec 19, 2012)

Chase said:


> What a Gem of a thread. Thanks for bringing it back from the dead


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## Anjel (Dec 20, 2012)

patzyboi said:


> Can you elaborate on the harm part here? I know COPD patients administering low amounts of oxygen over a period of time is ideal, but you shoudnt even withhold O2 if they are hypoxic



He isn't allowed on this forum anymore. Maybe someone else could answer though. I tired.


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## Achilles (Dec 20, 2012)

patzyboi said:


> Can you elaborate on the harm part here? I know COPD patients administering low amounts of oxygen over a period of time is ideal, but you shoudnt even withhold O2 if they are hypoxic



SOunds like you're a basic?

Answer. give o2 transport.


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## JDallas (Dec 20, 2012)

Well, since this thread is back from the dead, I'll chime in...

Never EVER EVER give a patient unneeded medication (o2, IV, Band-Aid, ANYTHING).

I have seen o2 have a beneficial phsyciatric (spell check?) effect. As a healthcare provider, don't we need to attend to ALL aspects of patient care? Applying oxygen *can* calm patients down, *possibly* lowering high pulse/BP caused by anxiety, and *potentially* prevent complications.


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## Aidey (Dec 20, 2012)

JDallas said:


> I have seen o2 have a beneficial phsyciatric (spell check?) effect. As a healthcare provider, don't we need to attend to ALL aspects of patient care? Applying oxygen *can* calm patients down, *possibly* lowering high pulse/BP caused by anxiety, and *potentially* prevent complications.



Psychiatric is the correct spelling, the word you actually want is either psychogenic or placebo and cite your source saying that oxygen can calm patients down and what complications are potentially prevented. A source explaining how oxygen can do this better than say talking calmly to the patient or holding their hand would also be helpful.


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## JDallas (Dec 20, 2012)

Aidey said:


> Psychiatric is the correct spelling, the word you actually want is either psychogenic or placebo and cite your source saying that oxygen can calm patients down and what complications are potentially prevented. A source explaining how oxygen can do this better than say talking calmly to the patient or holding their hand would also be helpful.



When a patient is stressed out (as they likely are during transport, its a very scary thing), their vitals can skyrocket... surely, you're aware of this.

When the patient belives that the EMT is actively treating them instead of just kicking back and watching, they calm down and the vitals begin to return to a normal range (typically).

As for potentially prevented complications... A pulse of 120 and BP of 150/100 (I have experienced this situation) places unnecesary strain on the cardiovascular system, which should be prevented, IF POSSIBLE, by the EMS crew.

As for specific evidence, all I have to say is that my Captain (EMT-I, 20 years experience) instructed me to do so and I have personally seen results. Keep in mind that its touch-and-go, and every patient reacts differently. Discontinue oxygen immediately if the patient isn't responding appropriately.

Above all, keep in mind that I am not an instructor, a doctor, or a renown scholar. It would be foolish to accept a new medical procedure based off of my statements.


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## NYMedic828 (Dec 20, 2012)

JDallas said:


> When a patient is stressed out (as they likely are during transport, its a very scary thing), their vitals can skyrocket... surely, you're aware of this.
> 
> When the patient belives that the EMT is actively treating them instead of just kicking back and watching, they calm down and the vitals begin to return to a normal range (typically).
> 
> ...



A BP of 150/100 and a HR of 120 is considerably low when you consider a person actively running can sustain a HR of 150-200. Unless there is a cardio-pulmonary or hemodynamically compromising pathology suspected those vitals aren't clinically significant other than to affirm a patient is in fact experiencing a behavioral issue.

Oxygen is an actual drug. We give it when indicated and only then.

Sugar pills are a placebo.

Sorry but your captain is mistaken. Just because someone has done something for 20 years doesn't mean they've been doing it right.


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## VFlutter (Dec 20, 2012)

To quote Vene, experience does not equal understanding. Giving oxygen to a patient who is not hypoxic is a medication error, plain and simple. Maybe you should just tell your patients that the saline flushes are medicine, ya know for the placebo effect.

But then again I ain't no scholar either


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## Veneficus (Dec 20, 2012)

I have typed out the pathophys many times.

start with this thread:

http://www.emtlife.com/showthread.php?t=32766&highlight=free+radicals


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## Veneficus (Dec 20, 2012)

*wow*



JDallas said:


> When a patient is stressed out (as they likely are during transport, its a very scary thing), their vitals can skyrocket... surely, you're aware of this.



Could I respectfully ask what you consider "skyrocketing?"

At what level do you consider them dangerously high?



JDallas said:


> When the patient belives that the EMT is actively treating them instead of just kicking back and watching, they calm down and the vitals begin to return to a normal range (typically).



On medicine, no news is good news. 

If you spend some time in a hospital, you will observe the most neglected patients are the least sick. 

You know what is scary? Being the patient that is commanding everyone's attention.

However, I advocate always appearing calm and collected, it gives confidence to patients. When  they see you have everything in control, they calm down.

Another thing that helps is explaining things to them. Like what is going to happen next, or the wait times, or what is going on with them.



JDallas said:


> As for potentially prevented complications... A pulse of 120 and BP of 150/100 (I have experienced this situation) places unnecesary strain on the cardiovascular system, which should be prevented, IF POSSIBLE, by the EMS crew.



Such vitals are not clinically significant in most patient populations.

This to me appears to be fear of the unknown influencing your judgement. You or your mentors do not know what scary looks like so it becomes fear of everything.



JDallas said:


> As for specific evidence, all I have to say is that my Captain (EMT-I, 20 years experience)



I am not impressed.



JDallas said:


> instructed me to do so and I have personally seen results.



Regretably, I doubt it. Correlation does not equal causation.




JDallas said:


> Keep in mind that its touch-and-go, and every patient reacts differently. Discontinue oxygen immediately if the patient isn't responding appropriately.



Have you considered the oxygen you apply today may take time off of a patient's life decades later? That it may reduce the quality of their life faster and increase their medical bills over time? Have you considered the stress involved with the elderly, particularly on a fixed income and immobile, and the negative health influences of trying to pay for and navigate the health system are?

Let me put it into perspective?

lets say a 65 year old male over the course of his life has lost X% of pulmonary function to age and various pathology.

Let's assume that you put them on 15l of NRB and drive them 30 minutes to the hospital. During this time, you observe them calm down.

3 or 4 months later they develop shortness of breath. They return to the hospital where they are now diagnosed with more advanced pulmonary deficency. They are now not able to carry on their daily routine and their quality of life and maybe even their income is reduced. Perhaps their renal function or liver function as well. 

Perhaps that person could have gone another 2-3 maybe 5 years without such a decrease if you hadn't overdosed him on oxygen?

Just something to think about... 



JDallas said:


> Above all, keep in mind that I am not an instructor, *(I am)* a doctor, *(this too)* or a renown scholar. *(and this)* It would be foolish to accept a new medical procedure based off of my statements*.(I think I make some pretty good medical arguments and have some insight*)


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## VFlutter (Dec 20, 2012)

Veneficus is my hero :wub:


----------



## Veneficus (Dec 20, 2012)

Chase said:


> Veneficus is my hero :wub:



You are too easily impressed then.


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## JDallas (Dec 20, 2012)

*One specific call*

On the specific call I mentioned with an HR of 120 and BP 150/100 (I belive, I don't have a perfect memory), maybe I should mention that the patient was an 80 year old inactive man., which is why those vitals concerned me.

Also, I do not advocate applying oxygen as a placebo. I ask the patient "Would you like me to start oxygen? It might help you calm down, but it won't benefit you much. Also, I highly doubt that 3 lpm over a 15 minute transport will cause an o2 overdose.

I'm not particularly interested in debating medicine with experts. My training is Basic (hence, I'm chatting in the Basic Life Support area) and I don't really want to embarrass myself in a high-level discussions with experts that have probably been experts for half of my life or longer. I will, however, speak with my medical director about this issue. If my usage of oxygen is innappropriate, I will discontinue the practice of using it to calm down patients. If not, I will continue to do what my department considers appropriate.

Thank you for the insights, and so long.


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## NYMedic828 (Dec 20, 2012)

Chase said:


> Veneficus is my hero :wub:



When will it be my turn to be super smart :sad:


----------



## Veneficus (Dec 20, 2012)

NYMedic828 said:


> When will it be my turn to be super smart :sad:



trust me, it is better to be sexy and stupid than smart.


----------



## CANDawg (Dec 20, 2012)

Veneficus said:


> trust me, it is better to be sexy and stupid than smart.



[YOUTUBE]15MwhPv3Ud4[/YOUTUBE]


----------



## Achilles (Dec 20, 2012)

since we are posting videos about sexy and smart, 
http://www.youtube.com/watch?v=d7hzcLZ7uRc
[YOUTUBE]http://www.youtube.com/watch?v=lj3iNxZ8Dww[/YOUTUBE]

this is the best one [YOUTUBE]http://www.youtube.com/watch?v=NrzXLYA_e6E[/YOUTUBE]


----------



## EMT B (Dec 20, 2012)

Veneficus said:


> I have typed out the pathophys many times.
> 
> start with this thread:
> 
> http://www.emtlife.com/showthread.php?t=32766&highlight=free+radicals



I noticed the term "free radicals" thrown around many times. I do not deem learning about those..can someone please shed some light as to what that is?


----------



## Aidey (Dec 20, 2012)

EMT B said:


> I noticed the term "free radicals" thrown around many times. I do not deem learning about those..can someone please shed some light as to what that is?



*deem  *

/dēm/
Verb
Regard or consider in a specified way.


I don't understand the rationale behind your question.


----------



## EMT B (Dec 20, 2012)

Autocorrect much? I meant to say i do not remember. Awk...


----------



## Anonymous (Dec 20, 2012)

EMT B said:


> Autocorrect much? I meant to say i do not remember. Awk...



http://lmgtfy.com/?q=What+are+free+radicals?


----------



## Tigger (Dec 20, 2012)

JDallas said:


> On the specific call I mentioned with an HR of 120 and BP 150/100 (I belive, I don't have a perfect memory), maybe I should mention that the patient was an 80 year old inactive man., which is why those vitals concerned me.
> 
> Also, I do not advocate applying oxygen as a placebo. I ask the patient "Would you like me to start oxygen? It might help you calm down, but it won't benefit you much. Also, I highly doubt that 3 lpm over a 15 minute transport will cause an o2 overdose.
> 
> ...



As someone (Christopher I think?) recently said, the plural of anecdote is not data.


----------



## NYMedic828 (Dec 20, 2012)

EMT B said:


> Autocorrect much? I meant to say i do not remember. Awk...



A free radical is essentially an atom with a missing electron in its outer valence shell. Any time an atom has an unpaired electron, or uneven number of electrons for that matter, it is considered to be unstable.

The stable form of Oxygen, is O2. It has 8 electrons in its outer valence shell.

The free radical of oxygen, otherwise known as "superoxide" is O2-. It has 7 electrons its outer shell. 

That unpaired 7th electron readily binds to, or in the case of ON- "attacks" whatever it comes across. The problem is that superoxide doesn't care what it goes after. It just seeks and destroys.

White blood cells such as neutrophils release superoxide amongst other things in order to kill off unwanted cells.

Free radicals of oxygen essentially form as a product of natural body chemistry. The issue with supplemental oxygen administration is the body only knows what to do with 21% oxygen. When we give it an extra 79%, and it doesn't have anywhere to put it, more free radicals form.

Your body can combat some of them through "antioxidants" which essentially sacrifice themselves to be destroyed by O2- for the greater good of protecting the body.

If O2- becomes overwhelming, it will start causing damage to the lining of the alveoli (type I pnuemocytes), the endothelium of vessels and hepatocytes (liver cells) amongst whatever other tissues it may come into contact with.


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