# High flow O2 contraindicated for embolic CVAs



## rescuejew (Mar 16, 2005)

With all the research thats going on in Durham at DUKE, a couple of docs have started research on high flow 02 in pts with embolic CVAs.  Their argument is, in the time it takes to initiate treatment and transport of the patient, the high-flow oxygen that we are used to providing actually causes capillary/vasoconstriction which may worsen the effects of these emboli.  Anybody heard anything comparable in their neck of the woods?  A lot of medics here are starting to put pts on NCs with acute embolic CVAs as long as they are portecting their airways.  Any thoughts?

GIN


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## Wingnut (Mar 16, 2005)

They told us this in EMT class.  AHA says for MI & CVA we are to give nasal Canula @ 4 lpm. NRB @15 lpm for anything else. Some of the medics here are following that, but many say they feel they're denying the pt much needed O2 and use the NRB. I'm kind of torn as to which is better.


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## rescuejew (Mar 16, 2005)

I'm from the school where CVAs and MIs got high-flow always if it was bad, and here we are still giving high-flow for bad MIs.  I had never heard of this for bad CVAs but the general concensus is as long as the pt is protecting thier airway then they get a NC.


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## EMTstudent (Mar 16, 2005)

In my class currently, we are being taught to apply 15 lpm by NR mask to any patient with an MI or CVA, unless they don't tolerate the mask... 

I am in Florida - are the actual protcols different than what they teach from the book???  What about on the NR?


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## Wingnut (Mar 16, 2005)

Really EMTstudent? Our book said NRB, but since AHA & DOT standards say Nasal Canula, that's what the registry will be wanting...I'm in FL too so check with your instructor. Ours made a big deal that 30% of the NR test is out of the AHA book, and we had to know the new standards to pass the test. Let me know what he/she says..I'd be interested to know.


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## rescuejew (Mar 16, 2005)

Well our protocols are very vague here, so we can operate within them.  We call medical direction for very little.  For example, we only call for MSO4 on the pain protocol, medics here can give it without calling for MIs.  BUT, the docs are kicking this idea around and some of the medics are following suit.  There has been no protocol devised...all of ours simply say: Appropriate Airway Management...lol


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## Firechic (Mar 16, 2005)

We've actually been using this concept in our protocols. Too much oxygen can be toxic to the patient. It can cause a potent vasoconstriction which can diminish cerebral blood flow. Also, too much oxygen can cause an excess of oxygen free radicals which destroys probably already ischemic tissue. 
Low flow O2 is the way to go for our dept. We monitor the patient's ETCO2 and determine and alter oxygen requirements according to those readings.


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## rescuecpt (Mar 16, 2005)

Our County protocols are different from the book, and sometimes the State (they can be better than State standards, but not worse).  It was a little confusing because the AHA Algorithms had drug dosages that we don't use, or we have drugs they don't use, etc.


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## EMTstudent (Mar 16, 2005)

> _Originally posted by Wingnut_@Mar 16 2005, 10:34 AM
> * Really EMTstudent? Our book said NRB, but since AHA & DOT standards say Nasal Canula, that's what the registry will be wanting...I'm in FL too so check with your instructor. Ours made a big deal that 30% of the NR test is out of the AHA book, and we had to know the new standards to pass the test. Let me know what he/she says..I'd be interested to know. *


 Yeah, it's weird.  We using the text book "Prehospital Care" by Brady... 

I will check with the instructor, because I know they have said before that what goes on in the field is different than what the national curriculum dictates...


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## SafetyPro2 (Mar 17, 2005)

Our EMS coordinator (medic with a neighboring department) brought up this issue at a drill on CVAs a few months ago, and said that while there is some evidence on this, he still recommends high-flow via NRB. I tend to agree, particularly with the short transport times we have.


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