# Oxygen and psychogenic shock



## RedheadErin (Aug 25, 2013)

For my final, I am being presented with a number of non-life-threatening but still painful and frightening injury scenarios. (Example, a pencil to the eye, amputated finger, etc)  I want to give my pretend patients oxygen as a prophylactic against psychogenic shock. How much do I give?


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## DrankTheKoolaid (Aug 25, 2013)

Not sure if troll......


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## RedheadErin (Aug 25, 2013)

How would that qualify me as a troll? :unsure:It's a reasonable question.


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## EMT B (Aug 25, 2013)

if this is a legitimate question then 2-4 via NC should be fine


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## RedheadErin (Aug 25, 2013)

Thank you.  That was what I wanted to know.


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## Achilles (Aug 25, 2013)

EMT B said:


> if this is a legitimate question then 2-4 via NC should be fine



So we're going to give oxygen just to say we have given oxeygen?


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## chaz90 (Aug 25, 2013)

Your pretend patients don't need oxygen. Tell me again what condition requiring oxygen you're treating? A finger laceration does not cause any condition for which oxygen can provide a benefit. Psychogenic shock? Are you referring to syncopal episodes post psychologically traumatic event? These are often vasovagal events that are self correcting. Also, if you're already there you have them sitting or on your stretcher and in no danger of passing out and hurting themselves. Seriously, don't over think this. Not every patient gets oxygen!


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## VFlutter (Aug 25, 2013)

You have asked a few questions about oxygen administration. Oxygen is a medication and like all other medications has a specific indication; hypoxemia. "Prophylactic for psychogenic shock" is not an acceptable indication for supplemental oxygen. Giving oxygen to a patient with normal oxygen saturation is a medication error, plain and simple. Oxygen is not harmless and can cause patients harm in certain situations. 

How will supplemental oxygen prevent a syncopal episode? You may want to study more about the pathophysiology of syncope. A P02 of 300 isn't going to help when you lose sympathetic tone...

If you absolutely have to apply oxygen because of a stupid protocol then give them 1L NC. Seriously.

Good article. 
http://www.medscape.com/viewarticle/778505_3


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## Handsome Robb (Aug 25, 2013)

15 lpm via non-rebreather.

/thread


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## STXmedic (Aug 25, 2013)

chaz90 said:


> Your pretend patients don't need oxygen. Tell me again what condition requiring oxygen you're treating? A finger laceration does not cause any condition for which oxygen can provide a benefit. Psychogenic shock? Are you referring to syncopal episodes post psychologically traumatic event? These are often vasovagal events that are self correcting. Also, if you're already there you have them sitting or on your stretcher and in no danger of passing out and hurting themselves. Seriously, don't over think this. Not every patient gets oxygen!


This.



Chase said:


> You have asked a few questions about oxygen administration. Oxygen is a medication and like all other medications has a specific indication; hypoxemia. "Prophylactic for psychogenic shock" is not an acceptable indication for supplemental oxygen. Giving oxygen to a patient with normal oxygen saturation is a medication error, plain and simple. Oxygen is not harmless and can cause patients harm in certain situations.
> 
> How will supplemental oxygen prevent a syncopal episode? You may want to study more about the pathophysiology of syncope. A P02 of 300 isn't going to help when you lose sympathetic tone...
> 
> ...


And this.



Robb said:


> 15 lpm via non-rebreather.
> 
> /thread



This should be grounds for the ban hammer.


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## Aprz (Aug 25, 2013)

It says he's a student. Y'know his instructors are probably veteran medics saying "you can never go wrong with oxygen; it's benign." On this foum, I know oxygen is a huge issue, but I think it's not as bad as we make it sound. In my opinion, it's mininally harmful in MIs and strokes. It can be very harmful to administer to neonates if excessive, paraquat poisoning, high dose over many hours, and in cardiac arrest if excessive. It's not beneficial for a lot of things we give it for in EMS, but it can lead to a poor outcome if not given when needed/indicated (just like any other meds).

OP, search the foumd in regard to oxygen administration, it's been discussed to death. Also search the web like Dr. Bledsoe, I believe it has mentioned on ems12lead, both EMS1 and JEMS had an article on it. Look up reperfusion injury and free radicals. Oxygen is not as benign as once though, but I don't think it's that bad either. Many medical professionals (especially EMS) are still behind the tines on it.


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## RedheadErin (Aug 25, 2013)

Aprz said:


> Y'know his instructors are probably veteran medics saying "you can never go wrong with oxygen; it's benign."



Yep.  That is my problem exactly.  I have to prepare myself for something like 60 possible scenarios.  The instructor likes to think up anything and everything that might happen/be considered/ever be imagined, so I want to be ready.  If he says "YOur patient is in horrible pain because he cut off 3 of his fingers with a circular saw.  He may faint," I need to know what to say to that.  Telling the patient to man up isn't going to be the answer!


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## STXmedic (Aug 25, 2013)

RedheadErin said:


> Yep.  That is my problem exactly.  I have to prepare myself for something like 60 possible scenarios.  The instructor likes to think up anything and everything that might happen/be considered/ever be imagined, so I want to be ready.  If he says "YOur patient is in horrible pain because he cut off 3 of his fingers with a circular saw.  He may faint," I need to know what to say to that.  Telling the patient to man up isn't going to be the answer!



You may have some insane amount of possible scenarios your instructor can give you, but as a basic there are only so many things you can do. If they're bleeding, stop it. Extremity injury? Don't let them move it. If they aren't breathing, breathe for them. No heart beat? Move blood for them. Your patients hypoxic? Give them oxygen. Unsure what to do? Drive fast. I think you may be over-thinking this a bit.


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## Aprz (Aug 25, 2013)

RedheadErin said:


> Yep.  That is my problem exactly.  I have to prepare myself for something like 60 possible scenarios.  The instructor likes to think up anything and everything that might happen/be considered/ever be imagined, so I want to be ready.  If he says "YOur patient is in horrible pain because he cut off 3 of his fingers with a circular saw.  He may faint," I need to know what to say to that.  Telling the patient to man up isn't going to be the answer!


I think you misunderstood what I was saying in that setence you quoted. I was kindly saying your instructors are wrong, if they are saying that about oxygen, but to give you a break since you're a student.  Students and new EMTs response to us when we say their instructor is wrong often is "but my instructor has been a fire/medic for 15 years! He is one helluva a medic!" Your instructors are credible, but credibility doesn't make you right.

I agree with STXmedic, there isn't much you can do. The NREMT expects you to follow an algorithm. No matter what, you will consider administering oxygen during the inital assessment, or when needed if the patient's condition changes which requires you to reevaluate ABC, or when needed. Typically their pattern is little sick gets low flow; big sick, MI, shortness of breath, stroke, and shock gets high flow. I disagree with this, but that's close to the algorithm. The rationale, which I disagree with, is that the oxygen will help your body compensating mechanisms (since you will be burning through oxygen quicker). Again, I disagree with this, but that's what the NREMT wants to hear from ya.


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## IslandTime (Aug 25, 2013)

Are we overlooking the placebo effect. I'm really new to this, an FF Probie in a combined department who will be continuing to EMT-B next year. We run aid calls to assist the EMTs and paramedics. On one run I watched with fascination as an end-tidal was placed on a patient with breathing difficulties and the symptoms eased... except the oxygen port wasn't hooked up to anything. Don't forget that the mind is a very powerful instrument.


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## RedheadErin (Aug 25, 2013)

I agree with you.  I was a medic in the national Guard and I was an ER Tech a long time ago, and I don't always think he is right.  But this week, he is the person who determines whether I am going to sit for the National or go back and do this class again.  So yeah, until Thursday, if he says the sun rises in the West, that had better be OK with me.  

I just want to know a simple thing.  I have about 5 scenarios where somebody has had something horribly painful and frightening but medically minor happen to them. It is feasible that the  instructor will say "even though he has not lost a lot of blood, he is pale, cool, and diaphoretic. He says he feels faint. What are you going to do?" I just want to know a reasonable response to that question.


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## VFlutter (Aug 25, 2013)

RedheadErin said:


> What are you going to do?" I just want to know a reasonable response to that question.



Well, what would you do? We are not going to just give you an answer


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## Jambi (Aug 25, 2013)

IslandTime said:


> Are we overlooking the placebo effect. I'm really new to this, an FF Probie in a combined department who will be continuing to EMT-B next year. We run aid calls to assist the EMTs and paramedics. On one run I watched with fascination as an end-tidal was placed on a patient with breathing difficulties and the symptoms eased... except the oxygen port wasn't hooked up to anything. Don't forget that the mind is a very powerful instrument.



This is malpractice and this mind set is part of the reason we get students on here asking these sorts of questions.  Before accepting this as a reasonable thing to do find anything about utilizing a drug or device to leverage the "placebo" effect. Find one protocol mentioning it, one EMS medical director advocating it, or a CE course training on it.

I'm not calling you out for this, but rather the practice and acceptance of it.  I despise lying to patients, and this is essentially lying.


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## chaz90 (Aug 25, 2013)

Jambi said:


> This is malpractice and this mind set is part of the reason we get students on here asking these sorts of questions.  Before accepting this as a reasonable thing to do find anything about utilizing a drug or device to leverage the "placebo" effect. Find one protocol mentioning it, one EMS medical director advocating it, or a CE course training on it.
> 
> I'm not calling you out for this, but rather the practice and acceptance of it.  I despise lying to patients, and this is essentially lying.



They weren't necessarily going for a placebo effect. I feel like I mention this too often on here, but I routinely place capnography cannulas on patients who are having a panic attack. I don't attach the oxygen tubing to anything, and I don't tell the patient I'm giving them any oxygen. I show them how low their "yellow CO2 number" is, explain why it's low, and coach them to slow their breathing as they watch it rise to what it should be.


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## RedheadErin (Aug 25, 2013)

Aprz said:


> The NREMT expects you to follow an algorithm. No matter what, you will consider administering oxygen during the inital assessment, or when needed if the patient's condition changes which requires you to reevaluate ABC, or when needed. Typically their pattern is little sick gets low flow; big sick, MI, shortness of breath, stroke, and shock gets high flow. I disagree with this, but that's close to the algorithm. The rationale, which I disagree with, is that the oxygen will help your body compensating mechanisms (since you will be burning through oxygen quicker). Again, I disagree with this, but that's what the NREMT wants to hear from ya.



I missed this when I wrote the last reply.  THAT is exactly what I needed to know.  

What would I do? If he is P, C, & D, I would put him in Trendelenburg's Position, give him a blanket, and give some O2.  Since his problem in these scenarios is relatively minor, I would give low-flow O2, but this is the part I was not sure about.  The book just says "give oxygen."


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## Handsome Robb (Aug 25, 2013)

Jambi said:


> This is malpractice and this mind set is part of the reason we get students on here asking these sorts of questions.  Before accepting this as a reasonable thing to do find anything about utilizing a drug or device to leverage the "placebo" effect. Find one protocol mentioning it, one EMS medical director advocating it, or a CE course training on it.
> 
> I'm not calling you out for this, but rather the practice and acceptance of it.  I despise lying to patients, and this is essentially lying.



Not necessarily.

It's pretty common to put ETCO2 on anxiety patients and show them their numbers and give them a goal to aim for after an explanation as to what will happen if they don't slow themselves down.


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## unleashedfury (Aug 25, 2013)

Chase said:


> Well, what would you do? We are not going to just give you an answer



+1000000000000

EMT School and paramedic school is based off of algorithms if your going by the NREMT-B standards Skill sheets. Just follow the skill sheet chromatically and you should be fine. They are available on their website for your use. 

OTOH use just simple logic that EMT school should have taught you. Scene Safety, U/P, number of patients and Mechanism of injury, or Nature of Illness. 

after that its the simplistic stuff. Go ahead and look for immediate life threats. Pt conscious breathing with a pulse. Hey you got an airway and they are breathing with the blood going round and round. Your already halfway there. 

If they are not conscious 
Are they breathing Yes? how well? if No Breathe For them. 
Is the heart beating? if not thump on the chest. and prepare your AED. 

Emergency medicine even at the basic standard is all about protocols and algorithms if you know them in your head and can fix the major life threats your already there.


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## IslandTime (Aug 26, 2013)

chaz90 said:


> They weren't necessarily going for a placebo effect. I feel like I mention this too often on here, but I routinely place capnography cannulas on patients who are having a panic attack. I don't attach the oxygen tubing to anything, and I don't tell the patient I'm giving them any oxygen. I show them how low their "yellow CO2 number" is, explain why it's low, and coach them to slow their breathing as they watch it rise to what it should be.



Bingo. We, that's the royal we as I was only observing, were only looking for the CO2 numbers. We didn't say anything about oxygen. The patient, pancreas transplant, kidney transplant, artificial leg, (I wanted to call my Lucky) was quite medically knowledgable. When he commented that his breathing difficulties had eased the paramedic held up the oxygen end and told him to blow into it to see if it helped. (You had to be there, the PT was really a great guy.) his reaction was kind of "uh, how about that." There was no effort to deceive. It was just the mind of somebody that knew that oxygen might help assumed that oxygen was flowing and helping.


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## Jambi (Aug 26, 2013)

Robb said:


> Not necessarily.
> 
> It's pretty common to put ETCO2 on anxiety patients and show them their numbers and give them a goal to aim for after an explanation as to what will happen if they don't slow themselves down.



It would seem that I misread ETCO2 part and thought oxygen/device used with out o2 hooked up to it.  I think my sentiment is correct, but sorely misdirected.  I'm going to put my foot in my mouth now. My apologizes to the involved parties involved.


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## IslandTime (Aug 26, 2013)

Jambi said:


> It would seem that I misread ETCO2 part and thought oxygen/device used with out o2 hooked up to it.  I think my sentiment is correct, but sorely misdirected.  I'm going to put my foot in my mouth now. My apologizes to the involved parties involved.



.


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## NomadicMedic (Aug 26, 2013)

This whole concept of blindly "appkying oxygen' to patients makes my head hurt.

It's 2013. When is this stuff going to end?


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## Jambi (Aug 26, 2013)

DEmedic said:


> This whole concept of blindly "appkying oxygen' to patients makes my head hurt.
> 
> It's 2013. When is this stuff going to end?



The new curriculum addresses this and even mentions spo2 sats < 95 etc.  those teaching just need to pay attention to it and stop war storying/in-the-field-we-do students.  It would help if the average EMS educator was actually educated and understood education, instruction adult learners, teaching methodology, pedagogy, etc...

My minor is in instructional design and delivery, so did get me started lol.  I just do what I can, when I can, and where I can to have what positive influence I can manage within the system I am forced to exist in.


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## chaz90 (Aug 26, 2013)

RedheadErin said:


> I missed this when I wrote the last reply.  THAT is exactly what I needed to know.
> 
> What would I do? If he is P, C, & D, I would put him in Trendelenburg's Position, give him a blanket, and give some O2.  Since his problem in these scenarios is relatively minor, I would give low-flow O2, but this is the part I was not sure about.  The book just says "give oxygen."



OP, just realize there is an enormous disconnect between the treatments from 1985 that EMT classes shove down your throat and what is actually done in the real world. BLS treatment for shock? Trendelenburg's (or as DEMedic is fond of saying, the "King County Fluid Bolus" ) is worthless, putting a blanket on a patient with a finger amputation for anything other than kindness or keeping them warm in a cold environment is ridiculous, and oxygen rounds out the trifecta of unnecessary "interventions." 

Real life treatment of this patient means stopping the bleeding, covering it so they can't see it, and taking the finger with you to the hospital. Apply a cool pack over the site to vasoconstrict and reduce swelling, and call for an ALS intercept for pain control.


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## Aidey (Aug 26, 2013)

RedheadErin said:


> I missed this when I wrote the last reply.  THAT is exactly what I needed to know.
> 
> What would I do? If he is P, C, & D, I would put him in Trendelenburg's Position, give him a blanket, and give some O2.  Since his problem in these scenarios is relatively minor, I would give low-flow O2, but this is the part I was not sure about.  The book just says "give oxygen."





DEmedic said:


> This whole concept of blindly "appkying oxygen' to patients makes my head hurt.
> 
> It's 2013. When is this stuff going to end?



Given the above quoted statement, the OP using a book from roughly 1989.


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## chaz90 (Aug 26, 2013)

Aidey said:


> Given the above quoted statement, the OP using a book from roughly 1989.



Hmm, I said 1985. Can we split the difference and go with 1987?


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## STXmedic (Aug 26, 2013)

chaz90 said:


> Hmm, I said 1985. Can we split the difference and go with 1987?



I would hope medicine has advanced a little since I was born :unsure: Time for an update I think...


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## Handsome Robb (Aug 26, 2013)

Jambi said:


> It would seem that I misread ETCO2 part and thought oxygen/device used with out o2 hooked up to it.  I think my sentiment is correct, but sorely misdirected.  I'm going to put my foot in my mouth now. My apologizes to the involved parties involved.



Sorry dude didn't mean to jump down your throat! 

I do agree with you though. It's along the same lines of giving a saline flush and saying you administered narcotic analgesics.


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## RedheadErin (Aug 26, 2013)

Aidey said:


> Given the above quoted statement, the OP using a book from roughly 1989.



Nope.  American Academy of Orthopedic Surgeons EMERGENCY Care and Transportation of the sick and injured 10th edition,  (c) 2013. 

It's right here on their website.  
http://emt.emszone.com/docs/CH10_AEC_Table.pdf

I understand this is not what you (or maybe anyone) would do in the field, but this is what I have to work with, right now.


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## chaz90 (Aug 26, 2013)

STXmedic said:


> I would hope medicine has advanced a little since I was born :unsure: Time for an update I think...



Medicine has advanced. We in EMS just continue to fight against progress. Apparently we take after our fire service brethren with the whole "40 years of tradition unimpeded by progress."  

I kid, I kid. Seriously, I think there are some very good medics, educators, and physicians that are trying to bring us into the modern age. I still try to have some sort of optimism about our future.


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## STXmedic (Aug 26, 2013)

chaz90 said:


> I still try to have some sort of optimism about our future.



My optimism is dissipating by the day. The poor providers staggeringly outnumber the good. Then, as mentioned earlier, these spectacular medics are the teachers of our students. It's a cycle with no end in sight.


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## Jambi (Aug 26, 2013)

chaz90 said:


> Medicine has advanced. We in EMS just continue to fight against progress. Apparently we take after our fire service brethren with the whole "40 years of tradition unimpeded by progress."
> 
> I kid, I kid. Seriously, I think there are some very good medics, educators, and physicians that are trying to bring us into the modern age. I still try to have some sort of optimism about our future.



Call it an epiphany or moment of clarity, but it occurs to me that (especially reading the link the the assessment and treatment for shock) that much of this is the result of forcing algorithmic approaches into what is increasingly becoming a clinical world where evaluation, critical thinking, critical application, and discretion is needed.  Furthermore, in the continued march of increased training and education, more and more is being added while the foundation of students (nothing really) is being kept sparse.

And we've hijacked the thread...


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## STXmedic (Aug 26, 2013)

Jambi said:


> And we've hijacked the thread...



Meh, the question has been answered several times already  Damn soapboxes... :lol:


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## mycrofft (Aug 26, 2013)

Read the text closely for uses and indications for oxygen administration. If you don't call for it, be ready to defend. 
The oxygen supplier I rarely work for says give everyone oxygen.


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## NomadicMedic (Aug 26, 2013)

Thread hijack or not, it's important for the OP to see why the majority of educated EMS providers are against the routine administration of oxygen.

Even though we may have compelling arguments against the routine use of oxygen or backboards or cervical collars… The response will always be, "but, that's not what the book says" or "this is the way my instructor said I have to do it". When you're new provider, and you don't know what you don't know, it's hard to argue with that type of logic.

We are certainly not ganging up on you Erin, although it may feel that way. Most of us are just disgusted with the poor state of EMS education.


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## VFlutter (Aug 26, 2013)

STXmedic said:


> My optimism is dissipating by the day. The poor providers staggeringly outnumber the good. Then, as mentioned earlier, these spectacular medics are the teachers of our students. It's a cycle with no end in sight.



There is always room over here on the dark side. We have cookies.


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## Meursault (Aug 26, 2013)

STXmedic said:


> My optimism is dissipating by the day. The poor providers staggeringly outnumber the good. Then, as mentioned earlier, these spectacular medics are the teachers of our students. It's a cycle with no end in sight.



Aww... I'm so proud of you!


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## Bullets (Aug 27, 2013)

Guys, if the patient had amputations of fingers, isnt that a distracting injury? And dont we place patients with distracting injuries in C-Spine precaution?

I cant believe you guys missed that over 5 pages of talk....for shame



{runs away}


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## mycrofft (Aug 27, 2013)

Here's a thought. If O2 can be "for reassurance", then it's mental and ought to be in the DSM, right?


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## AnthonyM83 (Aug 28, 2013)

Aprz said:


> On this foum, I know oxygen is a huge issue, but I think it's not as bad as we make it sound. In my opinion, it's mininally harmful in MIs and strokes.


 I don't know about minimally harmful in those specific cases.

But yes, this forum seems to be OVERCOMPENSATING and reacts violently to any talk of oxygen administration outside current recommendations, rather than matter of factly explaining the topic or just referring to an information source to educate.

Oh, here btw:
http://www.jems.com/behind-the-mask
http://www.ems1.com/columnists/mike-mcevoy/articles/1308955-Can-oxygen-hurt/


Fact of the matter is, we've given Oxygen to SO many stable (none major trauma / none respiratory / none MI....rather anxiety, broken bone, small laceration, general malaise) patients as a comfort measure who ended up being just fine. Probably not great for them, but if you're healthy I haven't been seeing studies about morbidity/mortality. Let's not blow it out of proportion to the Original Poster. No they should NOT give the finger laceration a cannula and the OP SHOULD be called out on it, but save the Overreactions for the experienced medic claiming O2 isn't bad...not for the green EMT student simply asking for advice on his/her final scenario.






unleashedfury said:


> EMT School and paramedic school is based off of algorithms if your going by the NREMT-B standards Skill sheets. Just follow the skill sheet chromatically and you should be fine. They are available on their website for your use.



Some schools like mine weren't really good with giving algorithms. I was very confused as to what to actually do when I got on-scene other than ask OPQRST questions...


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## AnthonyM83 (Aug 28, 2013)

Bullets said:


> Guys, if the patient had amputations of fingers, isnt that a distracting injury? And dont we place patients with distracting injuries in C-Spine precaution?
> 
> I cant believe you guys missed that over 5 pages of talk....for shame
> 
> ...



I'll give you a distracting injury.....


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## VFlutter (Aug 28, 2013)

RedheadErin said:


> Nope.  American Academy of Orthopedic Surgeons EMERGENCY Care and Transportation of the sick and injured 10th edition,  (c) 2013.
> 
> It's right here on their website.
> http://emt.emszone.com/docs/CH10_AEC_Table.pdf



I find it a little odd that an EMT textbook is written by a group of Orthopedic Surgeons. No Emergency Physicians or Trauma Surgeons. 

The majority of the Contributors/Editors are EMT-Ps. Some have bachelors or other degrees (MPA, MHA)  but many do not. There are very little advanced medical degrees listed.


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## Aidey (Aug 28, 2013)

Bullets said:


> Guys, if the patient had amputations of fingers, isnt that a distracting injury? And dont we place patients with distracting injuries in C-Spine precaution?
> 
> I cant believe you guys missed that over 5 pages of talk....for shame
> 
> ...



Go to your room before I ban you.


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## RedheadErin (Aug 28, 2013)

Just for curiosity, what is a better book to use?  

Thanks to y'all, I am thoroughly disgusted with this book  I had issues with it, anyway, like the way it tells you to use oxygen but doesn't give you any suggestions as to how much, contradictions in the text, and general poor organization.


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## STXmedic (Aug 28, 2013)

Your best and most informative books sadly won't have anything to do with EMT or medic.


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## Pavehawk (Aug 28, 2013)

Chase said:


> I find it a little odd that an EMT textbook is written by a group of Orthopedic Surgeons. No Emergency Physicians or Trauma Surgeons.
> 
> The majority of the Contributors/Editors are EMT-Ps. Some have bachelors or other degrees (MPA, MHA)  but many do not. There are very little advanced medical degrees listed.



You have to remember when the EMT program was first envisioned there were no "trauma surgeons" or Emergency Medicine doctors. The ED's tended to be staffed by IM docs (if they were lucky)or in smaller ERs GP's or whomever they could get including residents moonlighting. ( I have transported out of an ER where the opthomologist on duty was very very happy to see us)

Ortho docs were the main trauma providers and seemed like the logical folks to write the text for this new concept called the EMT.

The orange book and the Caroline are still AAOS but the vast majority of contributors are more correctly specialized in emergency work, though many are not formally educated with uber post nominals. The texts are not perfect (few texts are) and are hampered by needing to follow the national standard ciriculum which we all agree needs some more movement towards real science based medicine.

It seems we always come back to the education issue... too bad the powers that be don't see the trend


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## RedheadErin (Aug 28, 2013)

So here's a question: 

Say I get out on a call similar to the ones I was asking about. (a  real call, not something I have to get through in order to get out of this class)  Let's assume the patient cut of 3 fingers with a circular saw. (no c-spine trauma)  He is in horrible pain and he knows his career as a concert pianist is ruined. He is tachycardic, and tachypneic, which  is not surprising. He is pale, cool, and diaphoretic, and admits to fainting at the sight of blood, of which there is plenty. 

So he might faint, but he hasn't yet.  He has lost some blood, but not enough to think he could go into shock with from blood loss alone. We are about 30 minutes from a hospital. My partner wants to put him on Oxygen because that is what we learned in class.  

Are the odds more in favor of:

a. He does not need O2, and if I give it, it will cause harm
b. He might need O2, and if I withhold it, it will cause harm
c. He does not need O2, but if I give it, nothing will happen


Come to think of it, in most cases, which is the most likely outcome?


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## VFlutter (Aug 28, 2013)

RedheadErin said:


> So here's a question:
> 
> Say I get out on a call similar to the ones I was asking about. (a  real call, not something I have to get through in order to get out of this class)  Let's assume the patient cut of 3 fingers with a circular saw. (no c-spine trauma)  He is in horrible pain and he knows his career as a concert pianist is ruined. He is tachycardic, and tachypneic, which  is not surprising. He is pale, cool, and diaphoretic, and admits to fainting at the sight of blood, of which there is plenty.
> 
> ...



You did not mention the most important vital sign when trying to determine the need for supplemental oxygen.... Oxygen Saturation!. If he is at 98% on room air then there is no reason to give it. 

I would say C, pending sp02. If you absolutely have to give oxygen then throw 1-2L on. In reality you are not really increasing FI02 by much and it won't harm anything.  The problem is when you start putting people on 6+lpm and they come in with stupid high P02. If I had a dollar for every time I got a patient from EMS or a outside hospital with a P02 of 300+ I would have at least $10...A week. Or something like that.

I do not like the concept but I do understand there are protocols that require you to do certain things like administer oxygen. In all honesty 2L via NC is fine for pretty much any patient, even if they do not need it.


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## RedheadErin (Aug 28, 2013)

Duh!  I forgot the PulseOx.  :unsure: But that is why I am asking current practicing EMTs on this board, because you guys know and remember stuff like that.  My instructor has been out of the field for years, and my friends are just as clueless as I am (in fact, I think I am the valedictorian so far. That doesn't say much for my class, does it?)


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## NomadicMedic (Aug 28, 2013)

No ALS for pain management? Then proceed to step B. 

Step B: Put his fingers on ice, dress the wound and drive to the hospital. 

The end.


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## chaz90 (Aug 28, 2013)

In your scenario, I'd certainly say C. A couple LPM O2 for 30 minutes isn't going to cause any real harm in this minor trauma patient, but it's more a matter of doing something that doesn't need to be done in the first place. I understand where you're coming from, and I wouldn't say it's much different than most other EMT courses.


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## mycrofft (Aug 28, 2013)

Prove O2 IS reassuring. I'd prefer a sincere EMT who isn't busy "looking and hooking" gauges and machines to me.


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## Tigger (Aug 28, 2013)

I don't think I'd be that reassured if an EMT put my oxygen when I had cut my fingers, I'd think I might start freaking out that there was something wrong with my breathing. 

Or at least this is what friends tell me when I have posed similar questions in the "name of science."


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## AnthonyM83 (Aug 28, 2013)

Also, it can be a risky move to deviate from the standard of care that the rest of the country or textbooks are following. AHA 2010 Guidelines came out sometime in later 2010...you need quite a bit of time to rework a book and get it through publishing. And AHA only really addresses ACS and CVA type situations. PHTLS still said oxygen for major traumas. Whoever takes the first step is likely to screw something up or try to get blamed for something that goes wrong.

Not that it's a good excuse (since science against routine use of oxygen has been mounting for a long time now...)
Yet the standard of care has not been changing much until recently...


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## Aidey (Aug 28, 2013)

I'm not sure 3 fingers being amputated is major trauma in anyone's book, except for the guy who is missing the fingers.


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## NomadicMedic (Aug 28, 2013)




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