# Bag Valve Mask on the NREMT



## EMT91 (May 11, 2012)

I was wondering how I should handle a question like the one that follows:

You arrive at the scene of a track meet, where your patient, a 20 year old male complains of shortness of breath. He is breathing at 24 times a minute with good tidal volume. How do give o2?

A. Non reabreather 
B. Nasal Cannula 
C. BVM
D. FROPVD

I would say A, but since he is breathing at a slightly higher rate would you need to bag him?

I made that question up, not a test question.


----------



## NomadicMedic (May 11, 2012)

why would you give him 15LPM of oxygen on a NRB?


----------



## ABEMS (May 11, 2012)

If his tidal volume is good why would you bag him if hes breathing at 24 BPM. You would only bag someone if their resp are over 30, but even then not everyone will accept the BVM.


----------



## DesertMedic66 (May 11, 2012)

If the patient has good tidal volume then there is no point in using a BVM. If the patient is breathing at 30 times per minute with poor tidal volume then a BVM might be considered.


----------



## EMT91 (May 11, 2012)

n7lxi said:


> why would you give him 15LPM of oxygen on a NRB?



Because he has good chest rise and fall, but he is feeling short of breath...our class was taught that we basically give NRM 02 to almost all patients who have breathing issues.


----------



## EMT91 (May 11, 2012)

ABEMS said:


> If his tidal volume is good why would you bag him if hes breathing at 24 BPM. You would only bag someone if their resp are over 30, but even then not everyone will accept the BVM.



My book has a chart that says 16-20 is normal range for that age range, so I was confused as to what determines if its "too high" a rate.


----------



## DesertMedic66 (May 11, 2012)

EMT91 said:


> My book has a chart that says 16-20 is normal range for that age range, so I was confused as to what determines if its "too high" a rate.



Most books say that if it under 8 or above 24 resperations per minute then you should consider BVM. However you have to use that with your other assessment findings. 

How many people are breathing over 24 per minute after working out? Does John Q. Citizen get a BVM after working out? Nope. 

The key to the question is "good tidal volume".


----------



## EMT91 (May 11, 2012)

firefite said:


> Most books say that if it under 8 or above 24 resperations per minute then you should consider BVM. However you have to use that with your other assessment findings.
> 
> How many people are breathing over 24 per minute after working out? Does John Q. Citizen get a BVM after working out? Nope.
> 
> The key to the question is "good tidal volume".



Alright. I know what I would personally do, I would assume the rate is due to his being in a freakin race lol. I was just wondering for the NREMT exam.


----------



## mycrofft (May 11, 2012)

nasal cannula.
Or (E.):  TVWPAW*

(Take vitals, watch pt ,and wait)


----------



## KennyABC (May 12, 2012)

i would have chosen 15lpm via non-rebreather


----------



## usalsfyre (May 12, 2012)

NREMT answer? 15 via NRB.

Real world? Zip, zero, nada...


----------



## KennyABC (May 12, 2012)

usalsfyre said:


> NREMT answer? 15 via NRB.
> 
> Real world? Zip, zero, nada...




unforgettably you are correct with the real world application because i have witnessed this in training.  i assure every one i will be the guy using the one-time-use-only NRBs because THAT IS WHY THEY ARE THERE, give your patients o2!


----------



## Anjel (May 12, 2012)

KennyABC said:


> unforgettably you are correct with the real world application because i have witnessed this in training.  i assure every one i will be the guy using the one-time-use-only NRBs because THAT IS WHY THEY ARE THERE, give your patients o2!



*facepalm*

You do know that oxygen is a medication and is contraindicated at times, right?


----------



## jwk (May 12, 2012)

EMT91 said:


> I was wondering how I should handle a question like the one that follows:
> 
> You arrive at the scene of a track meet, where your patient, a 20 year old male complains of shortness of breath. He is breathing at 24 times a minute with good tidal volume. How do give o2?
> 
> ...



Since you made the question up - it's a poor question, because the answer would be "none of the above".  You have given ZERO indications to administer oxygen to this particular patient.


----------



## STXmedic (May 12, 2012)

KennyABC said:


> unforgettably you are correct with the real world application because i have witnessed this in training.  i assure every one i will be the guy using the one-time-use-only NRBs because THAT IS WHY THEY ARE THERE, give your patients o2!



:nosoupfortroll:


----------



## usalsfyre (May 12, 2012)

KennyABC said:


> unforgettably you are correct with the real world application because i have witnessed this in training.  i assure every one i will be the guy using the one-time-use-only NRBs because THAT IS WHY THEY ARE THERE, give your patients o2!



Care to explain the mechanisim by which O2 helps the majority of conditions? 



:waiting:


----------



## STXmedic (May 12, 2012)

KennyABC said:


> unforgettably you are correct with the real world application because i have witnessed this in training.  i assure every one i will be the guy using the one-time-use-only NRBs because THAT IS WHY THEY ARE THERE, give your patients o2!



Lol I do like that though process, though  Cric kits are in the ambulances! Cric your patients, medics! THAT IS WHY THEY ARE THERE! :rofl: :rofl: :rofl:


----------



## Anjel (May 12, 2012)

PoeticInjustice said:


> Lol I do like that though process, though  Cric kits are in the ambulances! Cric your patients, medics! THAT IS WHY THEY ARE THERE! :rofl: :rofl: :rofl:



I was thinking the same thing! lol 

I have epi pens. EPI FOR EVERYONE!


----------



## Akulahawk (May 12, 2012)

EMT91 said:


> I was wondering how I should handle a question like the one that follows:
> 
> You arrive at the scene of a track meet, where your patient, a 20 year old male complains of shortness of breath. He is breathing at 24 times a minute with good tidal volume. How do give o2?
> 
> ...


I would say that there's not enough info to make an appropriate determination about how much to give, if any. An athlete who is breathing 24 times per minute could very easily be attempting to recover from a bout of exercise... I have seen this many, many times. I would start at zero flow and go up from there, depending upon what I find during my assessment. 

Or I could just whip out the demand valve and let him breathe in at a flow rate of, say, 100 LPM???

I'm sure that NREMT's answer would be 15LPM by NRB. And no, I wouldn't pull out the BVM.


----------



## KennyABC (May 13, 2012)

PoeticInjustice said:


> :nosoupfortroll:



whats wrong with letting the athlete hold the nrb in his hand and takes a few sips from it?   i know if i were just racing around i wouldn't want a canula up my nose or even a nrb rubber band over my ears.  

but then again what do i know... i'm still just a student...


----------



## DesertMedic66 (May 13, 2012)

KennyABC said:


> whats wrong with letting the athlete hold the nrb in his hand and takes a few sips from it?   i know if i were just racing around i wouldn't want a canula up my nose or even a nrb rubber band over my ears.
> 
> but then again what do i know... i'm still just a student...



Why give him O2 at all? Why not, you know just let them breath the normal air (21% O2). Nothing in that assessment says that the patient needs any supplemental oxygen.


----------



## Handsome Robb (May 13, 2012)

KennyABC said:


> i would have chosen 15lpm via non-rebreather




For testing purposes I agree. In real life, look at your patient. 

For practical exams I've always used the line "I'll start with an NRB and if they don't improve quickly I'm going to switch to a BVM".


----------



## Martyn (May 13, 2012)

Why not get an SPO² reading to assess his sats?


----------



## NomadicMedic (May 13, 2012)

KennyABC said:


> but then again what do i know... i'm still just a student...



Since you're a student, why not do a search for "unnecessary oxygen EMS". Use your search engine of choice. Google Scholar will give you a few good hits. 

Now is the time to start furthering your education beyond the pablum that is fed to new EMTs.


----------



## m0nster986 (May 13, 2012)

Anyone consider a possible anxiety attack? lol


----------



## NomadicMedic (May 13, 2012)

m0nster986 said:


> Anyone consider a possible anxiety attack? lol



None of us considered anything, because there's not enough information given to determine what, if anything, may be the issue.


----------



## DesertMedic66 (May 13, 2012)

n7lxi said:


> None of us considered anything, because there's not enough information given to determine what, if anything, may be the issue.



I think the patient needs to have RSI. I mean it's the only way to truly control his airway and breathing rate


----------



## mycrofft (May 13, 2012)

Does the scenario even specify the pt IS an athlete?
No.


----------



## EpiEMS (May 13, 2012)

EMT91 said:


> I was wondering how I should handle a question like the one that follows:
> 
> You arrive at the scene of a track meet, where your patient, a 20 year old male complains of shortness of breath. He is breathing at 24 times a minute with good tidal volume. How do give o2?
> 
> ...



Generally healthy pt, with no hx, rx, or allergies?


----------



## EMTFozzy (Jun 1, 2012)

Ok quick question just about general O2. In EMT-B they teach ya to ALMOST O2 everyone. They say you have it give it. Now that I'm in my Paramedic class, we learn that too much O2 is not good! Why don't they teach too much O2 is not good in EMT-B?


----------



## Melmd (Jun 1, 2012)

EMTFozzy said:


> Ok quick question just about general O2. In EMT-B they teach ya to ALMOST O2 everyone. They say you have it give it. Now that I'm in my Paramedic class, we learn that too much O2 is not good! Why don't they teach too much O2 is not good in EMT-B?



They've been changing some study guideline lately ( O2 free radicals stuff) and slowly implementing it, and soon it will be on the national registry.


----------



## EMTFozzy (Jun 1, 2012)

Nice! Once I entered my EMT-P program they said and stressed and explained why not every pt needs O2 and the complications of too much O2!


----------



## Milla3P (Jun 1, 2012)

O2 treats hypoxia, not breathlessness. Coach his breathing and take an SpO2. Unless there's a CO issue, then get a Rad 47 and a hyperbaric. Something about being 600x more willing to bind with hemoglobin... 

Nobody gets O2. It's probably easier to get narcotics from me than O2. 

My instructor/partner would say "How many times have you walked into a supermarket and said to yourself 'Holy Crap! Look at that guy breathe!'" That guy gets O2. For most lung sounds you don't need a scope, either. If you can't hear LS from outside the house their not that bad.


----------



## Monkadelic (Jun 2, 2012)

i been taking the tests in that "success for the EMT" workbook that came with my brady 12th edition; but it is based off 10th edition stuff, and i missed that type of question the answer that book had was BVM because his respirations was over 20;  i initially put NRB @15 but i was wrong;  i realized them old books dont do any good helping you for current registry when i was missing blatant questions based off old scales;  heres an example;  contraindication of admin of NTG is BP of 90-100 or under 100 in the new edition so i put less than 100 for an answer; i got it wrong the answer was under 90.  i just hope they change the test bank each year to match up with new curriculums since this year is all about trauma.( the medic students all failed our module exam lol- they gave it to them before they started their trauma part of medic)


----------

