# Oxygen: Does it help with pain?????



## Comedic (Jul 29, 2008)

I am looking for information on if Oxygen help with pain.

I have found some information that supports that Oxygen helps with chest pain, back pain and migraines. But nothing else.


We put Oxygen on people and tell them this oxygen is going to help. I do it cause I know the brain thinks it's helping them.

I just need some information that support that if oxygen really helps with pain.


thanks


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## mikeylikesit (Jul 29, 2008)

Depends on where the "pain" is stemming from. Say that someone has the Bends, or nerve oxygen deprivation...then yes O2 can really make the pain go away. i think you're speaking of a placebo effect or a conversion disorder where it helps them if the brain thinks it is helping.


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## KEVD18 (Jul 29, 2008)

depends on the pain.

chest pain- sure does. think about it. what is an mi? death of heart muscle due to..... now, if the obstruction is only partial, and you can increase the oxygenation of the blood, ultimately getting more oxygen to the anoxic cells; wouldnt that lessen the pain?

traumatic amputation- very doubtful. the theory is that hyper-oxygenation produces euphoria. while it may be accurate on one level, pumping me full of o2 isnt going to make my stump feel better. fent will.

some people can be tricked into thinking oxygen will make them feel better. then again, some people can be tricked into spending 29.95 on a .75in round copper engraving of abraham lincoln.

the only benefit to superfluous oxygenation is that, with the exception of some conditions like respiratory drive conversion, the only way you can hurt someone with o2 is if you hit them with the bottle.


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## upstateemt (Jul 31, 2008)

KEVD18 said:


> some people can be tricked into thinking oxygen will make them feel better. then again, some people can be tricked into spending 29.95 on a .75in round copper engraving of abraham lincoln.




I don't think you are "tricking" people.  The placebo effect is well documented, just as in  the often used statement "pain is what the patient says it is when they say it is", releif comes in many forms.  Oxygen will not hurt someone and if the patient experiences a decreased level of pain because the oxygen makes them feel like something is being done, or in some way comforts them,  then you have performed a successful intervention.  There is no "trickery" involved.  

There are physiological reason that oxygen will help with pain but there are emotional responses that may decrease a patients level of pain as well.


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## KEVD18 (Jul 31, 2008)

there certainly is trickery. its merely trickery making use of the bodies natural processes(namely the placebo effect). its not trickery with harm intended, quite the opposite actually. 

i see what your saying, but i stand by my post.


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## upstateemt (Jul 31, 2008)

Well perhaps it is just semantics, but I don't think that is what you really mean....
Webster def of "trickery"

Main Entry: trick·ery  
Pronunciation: \ˈtri-k(ə-)rē\ 
Function: noun 
Date: 1796 : the practice of crafty underhanded ingenuity to deceive or cheat 
synonyms see deception


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## firecoins (Jul 31, 2008)

upstateemt said:


> Well perhaps it is just semantics, but I don't think that is what you really mean....
> Webster def of "trickery"
> 
> Main Entry: trick·ery
> ...



its semantics.  A placebo is a form of tricking people into believing that something is helpful and that it really becomes helpful.


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## upstateemt (Jul 31, 2008)

AHHHHHHH, again I refer to Webster:

Main Entry: pla·ce·bo  
Pronunciation: \plə-ˈsē-(ˌ)bō\ 
Function: noun 
Inflected Form(s): plural pla·ce·bos 
Etymology: Latin, I shall please 
Date: 1785 
1 a: a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder b: an inert or innocuous substance used especially in controlled experiments testing the efficacy of another substance (as a drug)
2: something tending to soothe

  placebo seems much kinder and gentler than trickery


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## firecoins (Jul 31, 2008)

upstateemt said:


> placebo seems much kinder and gentler than trickery


what you have against "trickery"? Medicine tends to "manipulate" the body to get certain reactions.  Does that bother you?


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## upstateemt (Jul 31, 2008)

As both  a nurse and an EMT I believe that being honest is important, "trickery" implies being less than honest.  If my patient were to ask me if oxygen would help their (fill in the blank) pain.  I would be honest in saying; I don't know but it won't hurt.


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## mikie (Jul 31, 2008)

maybe it's just me, but I don't consider O2, when used with patients in pain, as a 'placebo.'  Physiologically, it might not actually have an analgesic effect, but its more therapeutic. Helping one breathe, via O2 can in itself be therapeutic: controlling their breathing, giving them comfort of care...it all helps the patient cope with the pain rather than treat it.  

Like people that prefer homeopathic medicine (maybe a bad example, I'm not too up-to-date on my homeopathics).  

but that's just my small opinion...


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## upstateemt (Jul 31, 2008)

You are correct Mike, I regret my use of the word "placebo".  I was using it to describe a treatment that works but we don't really understand why, not to imply that the patient would be made to think it worked. 

Pain causes anxiety, anxiety may cause a perceived sense of being short of breath.  Oxygen can relieve that, resulting in a decreased sensation of pain.  A real treatment for a real problem. 

So my use of the word "placebo" is incorrect.


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## VentMedic (Jul 31, 2008)

I've got a little reading assignment for ya'all.      

http://cvphysiology.com/Blood Flow/BF008.htm

http://www.reuters.com/article/healthNews/idUSTON47321020080724?pageNumber=1&virtualBrandChannel=0

Our microsurgeons like their patients kept on O2 longer than other post-op patients.  This may be for pain relief, healing properties and anxiety factors involved. Maybe it just keep the leeches more active longer.   

upstate; as a BSN, CCRN, this should be very basic for you especially if you have done any ICU work.  Remember the reasons we utilize SvO2 and SjvO2 monitoring?   The SpO2 is deceiving.


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## upstateemt (Jul 31, 2008)

Thanks, I was looking for some journal articles to reference but ran out of time (I supposed to be working).  I did find alot of information on hyperbaric oxygen and pain control but no references to inhaled.   The hyperbaric oxygen therapy for migraines and cluster headaches seems to be greatly disputed.

I do know that all our patients with pain receive high flow O2 unless they refuse.  Annecdotely it works.


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## mikeylikesit (Jul 31, 2008)

I think that O2 is best used to cure a conversion disorder...along with a hand full of Tic Tac's.


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## mycrofft (Jul 31, 2008)

*O2...not your old man's gas.*

Placebo as in admistering a worthless treatment per se even if in the hope of postive effect is unethical and may be illegal, especially if you bill for treatment you don't give. (However, an O2 mask without O2 can be very swift in allaying hyperventilation; watch closely, don't leave it on very long!!!). Suggestion is different than placebo in that the placebo effect is internal to the pt in response to your positive suggestion, and no worthless treatment is administered..

Hyper-O2 can cause a climb in blood pH simulating hyperventialtion, especially if they ARE hyperventilating. If that goes on the breathlessness, and maybe even cramps and muscle contractions, will certainly NOT be helping alleviate pain.

O2 for decompression sickness is a palliative unless it is under hyperbaric pressure, but better than 21% room conc. Usually the O2 is via mask while the pt is placed in hyperbaric air, maybe a diver's mix.

Sometime, everyone ought to put on an O2 mask, and then (later, not concurrent) a nasal cannula, and see what it really is like, just like they oughta ride on the ambulance cot code three for a couple blocks.

PS: Good on y'all! No one came up with that old canard "If the pt has COPD, 
O2 will kill her".


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## MikeRi24 (Jul 31, 2008)

I agree with whoever said it could potentially help the chest pain or other o2 deprivation oriented problem. I also agree that for, lets just say for conversation sake, a broken leg, that while it's unlikely to help the pain caused by the broken leg, I think that giving it to a pt and encouraging them to take some deep breaths and whatnot will not only help calm them down, but by making them focus more on taking deep breaths and breathing in the o2, it will probably help take thier mind off the pain.


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## MMiz (Jul 31, 2008)

I absolutely believe that oxygen therapy helps with pain, though I can't tell if it's the actual oxygen or the whole "shebang" that makes the patient feel better.  Someone mentioned the placebo effect, and I agree.  Two stories.

When I was doing an EMS club at my school, I brought several bottles of  O2 and several NRB.  I had that, the LifePak 12, stretcher, etc. stored in the teacher's lounge.  One of the teachers went in there, hooked up the O2 via NRB @ 25 LPM !?! and took a small break.  By the end of the day there was a line out the door.

I remember once we were treating a patient for a jammed finger, and we had to transport to the hospital (per the guardian).  When I went to take the patient out of the rig, my partner had literally bandaged, splinted, and padded every part of her body.  She was on O2 via NC at 2 LPM.  I couldn't help but wonder what was going on.  When we dropped her off in the ER, the doctor asked what the heck was going on here, and my partner responded "Doc, if I would have offered to start bagging her with the BVM while shocking her with the AED, she would have said yes."  He just smiled and started taking the bandages off.

It's amazing what comforts patients, and I think O2 is one of those comforts.


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## VentMedic (Jul 31, 2008)

mycrofft said:


> Placebo as in admistering a worthless treatment per se even if in the hope of postive effect is unethical and may be illegal, especially if you bill for treatment you don't give. (However, an O2 mask without O2 can be very swift in allaying hyperventilation; watch closely, don't leave it on very long!!!). Suggestion is different than placebo in that the placebo effect is internal to the pt in response to your positive suggestion, and no worthless treatment is administered..
> 
> Hyper-O2 can cause a climb in blood pH simulating hyperventialtion, especially if they ARE hyperventilating. If that goes on the breathlessness, and maybe even cramps and muscle contractions, will certainly NOT be helping alleviate pain.
> 
> ...




Hyperoxia is not hyperventilation.  The Hb will reach their saturation point and the partial pressure of the PaO2 will remain.   We will put patients on high concentrations of O2 for various protocols including sepsis until the serum lactate starts to decrease.  

Putting a mask without O2 on anyone is like putting someone in a plastic bag.  You, in the prehospital situation, do not know the cause of the "hyperventilation" which can trully only be determined by an ABG.  You will have no idea what the acid-base situation is  or if there is significant V/Q mismatching.  In the ED I've intubated more than one of these "victims" of some EMS provider assuming "hyperventilation".   People who can not breathe tend to get a little anxious.  

Giving the patient a little O2 may do more to alleviate their "hyperventilation". 

As for as DCS, oxygen is not just pallative.  You can find this information on either the DAN website or The Undersea & Medical Society.

http://www.diversalertnetwork.org/

http://www.uhms.org/Default.aspx?tabid=270



> The use of first aid oxygen has proven so beneficial that the Divers Alert Network (DAN) has made a major effort to place oxygen at dive locations, in particular those that are remote with lengthy transport times to the nearest hyperbaric chambers and to ensure that people are trained in its use. A study of the use of first aid oxygen found that the median time to its use after surfacing was 4 hours and 2.2 hours after the onset of DCS symptoms. Forty-seven percent of victims received the oxygen.  Complete relief of symptoms was found in 14% of victims. Even more striking was that 51% of victims showed improvement. This was with the oxygen before HBO treatment. Even after a single HBO treatment, those that had received oxygen before the HBO dive, even if many hours earlier, had better outcomes.


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## Comedic (Aug 1, 2008)

I want to thank everyone for answering my thread............ good stuff

I have to agree on placebo effect. I have put countless patients on oxygen telling the that it will help. Then of course when it didn't help I would load them on some Fent.

It just seems to me we would put oxygen on patients to clam them down and if you plan not giving the patient any pain control. 

Wouldnt that help wear off the endorphins or even wear off the Epi dump in the system.

Don't get me wrong I'll still put oxygen on when needed. If someone refuse oxygen I will still tell them that it will help.

So oxygen has to help in some way excluding the placebo effect and in any respiratory distress. Let think about how it works on a trauma patient. Does it help the healing process by situation of oxygen to tissues. If not then why do we monitor PsO2 and keep it above 90%.


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## mycrofft (Aug 1, 2008)

*Ventmedic, I agree, and I disagree.*

"The Bends"...it depends upon the severity. I said it was better than nothing, but until those gas bubbles causing circulatory occlusion are physically out of there, the damage continues. Non-hyperbaric O2 at mean sea level pressures can help by increasing the possibility of O2 perfusion of a gas embolized area via collateral circulation etc, but if the gas embolism gets bad enough there's going to be an infarct if primary circ is not reestablished, and nonhyperbaric 
O2 simply cannot do it in time if at all in serious cases. If it could, the U.S. Navy would just put their "bent" divers on O2 instead of jetting them to recompression/decompression centers.

The DAN study is not a scientific statistically controlled or double blind study but an empiric observation, no control group or accomodation for the confounders of false diagnoses and the number of bent folks who each year spontaneously reabsorb and recover. Despite that, I agree that O2 still ought to be administered as it is the best/only measure until proper recompression then decompression are achieved for the more serious cases.

(When I was at Travis AFB's David Grant Medical Center I cared for a non-bends hyperbaric pt. Different gas mixes were administered to people via mask while sitting in a hyperbaric overall environment, quite large, more of a "parlor" than a "tank").

Hyperoxia in the field is pretty rare, versus hyperventilation, which in the field is not _too_ rare. In either event, whether it is the primary diagnosis or not, you displace CO2, which raises pH and makes haemoglobin less able to swap O2 for CO2, causing the _S/S_ in the field, and the tx is the same: less O2. 

As for "knowing the cause of the hypeventilation", I agree, but I might use the phrase "knowing how to differentiate between hyperventilation and struggling to get enough air"; _as you are getting the pt to the hospital_, you are assessing them, and some O2 won't kill either and will help the person who is suffocating. (I don't ever use the clasic brown paper bag, I have hyperventilators breathe through their t-shirt  and answer a barrage of questions which forces them to stop long enough to talk, then breath warm humidified rebreathed air; if they get worse or resist, I switch to O2). Theoretically, the gold standard would be field ABG's, but in the field and on the way to defintive care, treat the clinical signs and symptoms, keep 'em alive, but get 'em in.

The stunt with the O2 mask...I was trying to be ironic, when I've seen it work it was accidental and the mask was on (but not the oxygen) for about fifteen seconds. I once picked up a pt from a nursing home, they hoped to get the pt out before she died, to keep their statistics looking good. Amazing how she perked up when we turned her mask O2 from 2 LPM to 8 for a while!

My apology. From now on when I'm wisecracking or being ironic, I'll try to remember to use an emoticon, I forget some folks will take it seriously because they are new to it, etc.


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## VentMedic (Aug 1, 2008)

mycrofft said:


> The DAN study is not a scientific statistically controlled or double blind study but an empiric observation, no control group or accomodation for the confounders of false diagnoses and the number of bent folks who each year spontaneously reabsorb and recover. Despite that, I agree that O2 still ought to be administered as it is the best/only measure until proper recompression then decompression are achieved for the more serious cases.
> 
> 
> Hyperoxia in the field is pretty rare, versus hyperventilation, which in the field is not _too_ rare. In either event, whether it is the primary diagnosis or not, you displace CO2, which raises pH and makes haemoglobin less able to swap O2 for CO2, causing the _S/S_ in the field, and the tx is the same: less O2.
> ...




DAN referenced articles from studies done at hyperbaric centers.   You can pull up the actual studies in the references.

Hyperoxygenation increases the PaO2 and does not increase the pH.

Your "hyperoxia" level on 21% or room air will be limited by where you live. 

Hyperventilation decreases the PaCO2 and will increase the pH but it may still be in the acidotic range in such cases as sepsis and DKA.
People with pulmonary emboli will "hyperventilate".  We do not reduce their O2.   Serious shunting and V/Q mismatching?   Pneumothorax?   We will still do hyperoxygenation for pneumos to displace the nitrogen as a conservative treatment. 

Tachynea is a better word to use in the field as a descriptive term since you actually do not know what is happening to the patient medically.  If you decide not to transport a patient based on your "hyperventilation" assumption and the patient later requires hospitalization or worst, that word will be picked apart on your run sheet.   

A pt can be tachyneic and appear to be "hyperventilating" when they are actually nearing respiratory failure.  Kids present this way.   Their PaCO2 is climbing along with their pH.

Unless you are absolutely certain it is from an emotional issue from *just one *time.  If it is known to be recurrent,  this can bring it to a true medical dx which must also be treated by professionals for Hyperventilation Syndrome.

Don't assume and do a good assessment.


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## VentMedic (Aug 1, 2008)

Spelling correction: Tachypnea

As far as my comment about hyperoxia and where you live:

http://www.lib.mcg.edu/edu/eshuphysio/program/section4/4ch3/s4ch3_14.htm

http://www.globalrph.com/martin_4_most2.htm

      PAO2 = ((Pb - 47) x FiO2) - PaCO2/0.8 


While PCO2 is factored into the equation, The A-a gradient will not be significantly alarming on 21%.

To do studies for the effect of "hyperoxia", we use an nonrebreathing O2 circuit.  That is very different from a NRBM used in the field.

DCS also comes with many other clinical manifestations that require oxygen for treatment.   

www.medscape.com


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## mikeylikesit (Aug 3, 2008)

VentMedic said:


> Giving the patient a little O2 may do more to alleviate their "hyperventilation".


 I agree, most of the time it may not present with ketone's or other such marker to inform you of the patients Ph balance, therefore like you said i give them O2 in any case.


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## cakilcrease (Aug 3, 2008)

pain happens due to the lack of oxygen.  think about it, cardiac ischemia; one of the related signs and/or symptoms is chest pain, when we give oxygen it helps to relieve the pain.  this is true with any pain, even in trauma, like a laceration, that portion of the body is no longer intact meaning that perfusion to that portion is lost, and when we perfuse we bring oxygen to the parts of the body that need it.  this is what i have been taught by my paramedic instructor and it makes too much... besides it helps us to remember to never deprive a patient of oxygen.


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## Somedude (Aug 10, 2008)

*Oxygen...*

Why oxygen has been known in some circles as a "mircle drug." For significant medical pains and significant MOI oxygen is a proper treatment. But as for just isolated trauma and muscular pain...why not just treat the pain? It is our job to be paramedics, to make people feel a little better and get them to the hospital safely for difinitive treatments. Better to address the main complaints and life threats before attempting to "comfort" the pt. with something that must be discussed if it does actually work. Why not just give the morphine, fentynal, toradol, ect. if not contrainidicated. It is not a very scientific reason, but it is also our job to help the pt. with what we can and as efficently as possible.


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## Hastings (Aug 11, 2008)

Somedude said:


> Why oxygen has been known in some circles as a "mircle drug." For significant medical pains and significant MOI oxygen is a proper treatment. But as for just isolated trauma and muscular pain...why not just treat the pain? It is our job to be paramedics, to make people feel a little better and get them to the hospital safely for difinitive treatments. Better to address the main complaints and life threats before attempting to "comfort" the pt. with something that must be discussed if it does actually work. Why not just give the morphine, fentynal, toradol, ect. if not contrainidicated. It is not a very scientific reason, but it is also our job to help the pt. with what we can and as efficently as possible.



By your logic, why not do both?


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## Somedude (Aug 11, 2008)

Just simply, why waste the time? There is nothing of an "placibo" effect that a cannula with provide that you cant just simply talking to the pt. enroute to the hospital with a cocktail of magic drugs on board.


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## Hastings (Aug 11, 2008)

Somedude said:


> Just simply, why waste the time? There is nothing of an "placibo" effect that a cannula with provide that you cant just simply talking to the pt. enroute to the hospital with a cocktail of magic drugs on board.



Without sounding too...

How long does it take you to give a patient oxygen?


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## Somedude (Aug 11, 2008)

Hastings,
Very true, it doesnt take very long at all. After reading this forum it seemed to me that people are thinking much too deeply into this issue. Just as my opinion, if they don't need the O2, why waste any further time, energy, money, and my supply to administer oxygen when I can give meds or provide BLS manuvers to make the pt. just as comfortable. Also I do believe that truely being there just to talk with pt, wearing that uniform, and reassuring them can do worlds more than any procedure. All that leading back too, lets just fix the problem...the pain.


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## Hastings (Aug 11, 2008)

Somedude said:


> Hastings,
> Very true, it doesnt take very long at all. After reading this forum it seemed to me that people are thinking much too deeply into this issue. Just as my opinion, if they don't need the O2, why waste any further time, energy, money, and my supply to administer oxygen when I can give meds or provide BLS manuvers to make the pt. just as comfortable. Also I do believe that truely being there just to talk with pt, wearing that uniform, and reassuring them can do worlds more than any procedure. All that leading back too, lets just fix the problem...the pain.



Well, after experiencing this thread, I'd "waste" the time, energy, and money just to get a consensus on whether or not oxygen helps with pain. I'm all curious now.


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## reaper (Aug 11, 2008)

I think we should just take O2 off the truck. This placebo isn't helping anyone, anyways!


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## Somedude (Aug 11, 2008)

Hey hastings, you gotta let me know how that goes. Maybe ill try a little of that oxygen stuff anyhow just too see how it all works anyway...lol.


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## ffemt8978 (Aug 11, 2008)

Play nice, people.


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## Hastings (Aug 11, 2008)

Somedude said:


> Hey hastings, you gotta let me know how that goes. Maybe ill try a little of that oxygen stuff anyhow just too see how it all works anyway...lol.



To be serious, I think it's impossible to tell. I always ask "is that oxygen helping at all" in habit, but it's a stupid question. And what is a patient really going to say? They can say three different things, but neither is really a reliable answer. I give oxygen because the body naturally needs it for almost all processes, it's cheap, there is no downside, and there's no evidence that suggests oxygen DOESN'T help. Oh, and habit. 

Besides, with all the TV shows about medicine on today, I'd be surprised if anyone called an ambulance NOT expecting to be put on oxygen. It's just one of those things. Usually, I'm against giving a treatment that doesn't have a proven purpose, but...


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## csly27 (Aug 11, 2008)

Trickery just sounds not very nice, when it comes down to it the important thing is to ensure that the pt is getting the best possible medical care, and if that means telling them that the o2 is gonna help them,  I think in most cases it will help in one way or another but remember I am just an emt in training.


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## Somedude (Aug 11, 2008)

I do understand just exactly what your saying. In the world today though most people c/o a problem and call 911. If that is the case, paramedics should provide whatever care to enable the pt. to be relieved of the complaint. In my experience, pt. call 911 for pain quite a bit. Why not make them as close to pain-free as protocol allows with medication. Its most effective, quicker, and more efficenicent then sitting on-scene hooking up oxygen. Your right, oxygen has no side effects so in a sense, why not is just fine. I do administer oxygen when I administer morphine, but it is given to reverse any chance of respiratory compromise. Either way...this thread does prove to be intresting...


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## Hastings (Aug 11, 2008)

Somedude said:


> I do understand just exactly what your saying. In the world today though most people c/o a problem and call 911. If that is the case, paramedics should provide whatever care to enable the pt. to be relieved of the complaint. In my experience, pt. call 911 for pain quite a bit. Why not make them as close to pain-free as protocol allows with medication. Its most effective, quicker, and more efficenicent then sitting on-scene hooking up oxygen. Your right, oxygen has no side effects so in a sense, why not is just fine. I do administer oxygen when I administer morphine, but it is given to reverse any chance of respiratory compromise. Either way...this thread does prove to be intresting...



Good point about oxygen administration and respiratory compromise caused by pharmacology.

You'll be sitting on scene starting that IV to give the drugs though. It's just too convenient not to have someone hook up the oxygen at the same time. Call it trickery, but it does also give the patient the "illusion"(?) that you're doing absolutely everything you can to help them.

But I do give you kudos. I strongly believe that a paramedic should provide all pain control that is possible given the situation. Making people comfortable is a big part of the job; that's something we can agree on.


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## Somedude (Aug 11, 2008)

Agreement sounds good buddy. Intresting conversation tonight. Well take care and have a good night...and dont be working too hard....


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## cakilcrease (Aug 14, 2008)

there are those of us who cannot give morphine or anything like that, some times o2 is the only option. and even if it is a "placebo" the way i have been taught and the way i have been practicing is that we are to not only provide care up to the point that we are allowed to but to also provide assurance that we do everything that we can do for them not to just give them the blanket of assurance that we are and just sit back and roll our eyes.  i for one am a big believer in o2 therapy.


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