# low flow o2 and vomiting



## flemt92 (Oct 29, 2011)

i had a patient the other day that was vomiting for 8 straight hours, when i was in the back with her she began to vomit some more. at one point i remembered what my instructer told us once in class, he said that low flow oxygen can help reduce nausea and vomiting. so i placed my pt on a NC @ 2 L/M either way because her sao2 was at about 92%, but her condition went unchanged. i was wondering if anyone else has tired this with a pt suffering nausea and vomiting.


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## Yarbo (Oct 29, 2011)

Oxygen is known to be somewhat of an antiemetic. I'm sure everyone will have their opinions on this.


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## DesertMedic66 (Oct 29, 2011)

I've never heard of Oxygen helping vomiting. As for a NC when your patient is vomiting well that's common seeing how a NRB mask isn't a good idea.


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## Aidey (Oct 29, 2011)

Frankly, if I am vomiting, the last thing I want is something blowing the nasty new plastic smell in my nose. 

I've heard this too, but I'm pretty sure it is an old wive's tale and does not apply to any patient's who are not hypoxic.


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## DV_EMT (Oct 29, 2011)

I've heard that O2 helps Nausea/Vomiting & Pain. I know that many people will go Tachy or Brady when they vomit as well, which in turn could (minimally) reduce their SPO2 saturation.

Personally, If someones condition is not contraindicated with giving O2, I'll give it. Never really hurts anyone, unless bludgened by a D cylinder.


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## Aprz (Oct 29, 2011)

Interesting. I decided to look this up and read online (http://www.ncbi.nlm.nih.gov/pubmed/20613542) that it may help with N/V if caused by elevated serotonin levels in the GI system, and oxygen would inhibit serotonin. I also checked out other websites looking for the relationship between serotonin and N/V, and the relationship between oxygen and serotonin; there are some articles. It's too late for me to further investigate this, but I didn't think serotonin in the GI would increase the likeliness of N/V, nor did I know that oxygen significantly effected serotonin production. According to this pubmed article, which was done on colon surgery patients, >80% oxygen was the effective amount so I have my doubts with low dose of O2, and doubt that an NRB would be practical. Even with this information in mind, it's important to consider the orgin of the N/V before administering O2.


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## usalsfyre (Oct 29, 2011)

DV_EMT said:


> Never really hurts anyone, unless bludgened by a D cylinder.









High concentration O2 *may* have some effect on N/V, but ondansetron, phenegran, droperidol or even diphenhydramine are much better choices. If intractible N/V can be cause for an admit, don't your patient's deserve ALS?


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## DV_EMT (Oct 29, 2011)

usalsfyre said:


> High concentration O2 *may* have some effect on N/V, but ondansetron, phenegran, droperidol or even diphenhydramine are much better choices. If intractible N/V can be cause for an admit, don't your patient's deserve ALS?



I'm on  a BLS rig.......    we don't get those cool drugs


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## Aidey (Oct 29, 2011)

Aprz said:


> Interesting. I decided to look this up and read online (http://www.ncbi.nlm.nih.gov/pubmed/20613542) that it may help with N/V if caused by elevated serotonin levels in the GI system, and oxygen would inhibit serotonin. I also checked out other websites looking for the relationship between serotonin and N/V, and the relationship between oxygen and serotonin; there are some articles. It's too late for me to further investigate this, but I didn't think serotonin in the GI would increase the likeliness of N/V, nor did I know that oxygen significantly effected serotonin production. According to this pubmed article, which was done on colon surgery patients, >80% oxygen was the effective amount so I have my doubts with low dose of O2, and doubt that an NRB would be practical. Even with this information in mind, it's important to consider the orgin of the N/V before administering O2.



Zofran works on the serotonin 5-HT3 receptor. That should help you with your searching.


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## usalsfyre (Oct 29, 2011)

DV_EMT said:


> I'm on  a BLS rig.......    we don't get those cool drugs


So you refuse to call a paramedic so those drugs are available?


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## DV_EMT (Oct 29, 2011)

usalsfyre said:


> So you refuse to call a paramedic so those drugs are available?



Our provider is BLS only.... meaning no ALS rigs

Transport time to hospitals in LA is about the same amount of time as calling in an ALS Rig... unless you're in traffic... unless you get auth to got Code... which would never happen for N/V....


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## usalsfyre (Oct 29, 2011)

Ahhh, southern CA, explains a lot.

O2 is not gonna do a darn thing most of the time, just hurry up and get you pt to the ED, which is generally all the basic level can do anyway.


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## firetender (Oct 29, 2011)

Don't neglect the psychological effect of placing the O2 mask on the patient, saying this may help and setting their focus on their breathing.


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## Aprz (Oct 30, 2011)

Aidey said:


> Zofran works on the serotonin 5-HT3 receptor. That should help you with your searching.


I did not know that. Thanks for the info! I should've thought about looking into how anti-emetics work, haha.


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## Aidey (Oct 30, 2011)

Not all anti-emetics, there are a couple different types of anti-emetics, Zofran et al just happen to be the ones that work on serotonin. Others work on dopamine and H1 receptors.


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## 18G (Oct 30, 2011)

Acetylcholine is also a neurotransmitter for nausea.


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## Aprz (Nov 3, 2011)

I gave this a shot the other day with a patient after her radiation treatment.

It was a wait and return radiation therapy appointment for a early 40s female who had cancer all over unfortunately. Before treatment, she had no complaints. After treatment, she was feeling nauseous and dizzy (I thought of toxins, not dialated blood vessels, when I heard she was dizzy). The staff there wanted to give her a tab to help the nausea, but after calling her nurse at the facility we were gonna return her to, they decided the facility we were gonna return her to would give her Zofran every 7 hours (they called the nurse about it). Prior to transporting her back, I brought this up with my partner who was the attendant for the call, and he agreed to put her on oxygen. I was afraid to put it at 6 L/m because I didn't want to dry up her nasal mucosa, but I remember reading that around FiO2 0.8 was the therapuetic amount in the research, and 6 L/m is only around 0.39-0.44 depending how you calculate it, half the dose the research said, but I didn't want to put her on a NRB either cause I was afraid I'd freak out the staff when we returned/get the "wtf" look. My partner thought 4 L/m would be too much, but he went with it anyhow. 4 L/m (0.33-0.36) didn't help per patient, but we were only with the patient for about 15 minutes. Oxygen was dc'd at the receiving hospital, and the patient was administered Zofran by the RN there.

That's my experience with it so far.

Do you guys think that I should've gone with a NRB anyhow? Is it okay to let the patient wait 15 minutes for her medication? Is it okay to give her a drug that has other consequences such as free radicals, vasoconstriction, and stress on the cells especially if she's gonna get a better drug in 15 minutes? From my understanding, the free radical issue is with reperfusion... and I don't think occlusion was an issue here.


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## Akulahawk (Nov 3, 2011)

I probably would have simply transported her in a position that provides her comfort and kept an emesis basin or bag handy. If she's not short of breath and vitals seem to be about the same as they were at drop-off, I'd have withheld the oxygen. About the only way I'd have provided O2 for her would have been by NRB, hand-held by patient, for a brief trial period. Personally, I doubt it would have made much difference. Getting the patient back to the facility where she could get Zofran would have been preferred.


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## Aprz (Nov 3, 2011)

Akulahawk said:


> About the only way I'd have provided O2 for her would have been by NRB, hand-held by patient, for a brief trial period. Personally, I doubt it would have made much difference. Getting the patient back to the facility where she could get Zofran would have been preferred.


She was holding an emesis basin, transport wasn't delayed, but that sounds like an interesting idea having the patient self administer it with the NRB.


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## medicaltransportflorida (Nov 3, 2011)

Oxygen is accustomed to be rather of an antiemetic. I am assertive everybody will accommodate their assessment on this. If anyone accompaniment is not contraindicated with accommodating O2, I will accord it. Not at all in fact aching anybody, unless bludgeoned by a D tube.


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## Devilz311 (Nov 3, 2011)

usalsfyre said:


> High concentration O2 *may* have some effect on N/V, but ondansetron, phenegran, droperidol or even diphenhydramine are much better choices. If intractible N/V can be cause for an admit, don't your patient's deserve ALS?



Ha... A certain ALS project near me  didn't start carrying anti-emetics until about a year ago. And to top it off, most of the Medics that work there would absolutely blow a gasket if a squad requested them for N/V...

... And people wonder why I drive 45 miles to work elsewhere


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## usalsfyre (Nov 3, 2011)

Devilz311 said:


> Ha... A certain ALS project near me  didn't start carrying anti-emetics until about a year ago. And to top it off, most of the Medics that work there would absolutely blow a gasket if a squad requested them for N/V...
> 
> ... And people wonder why I drive 45 miles to work elsewhere



These are some folks who need to get nauseous and then driven around  in the back of an ambulance for a while. 

(Once had a stomach bug hit while on a HEMS call. Changed my views in anti-emetics entirely).


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