# Use of O2



## tiff_yates (Jul 7, 2010)

I took the NREMT-B test and I failed the first time. The one thing that sticks out that I had the most trouble with was oxygen treatment. My question is, is it better to use a BVM or a NRM on the test? And if you are supposed to use both when do you use a BVM and when do you use a NRM? PLEASE HELP


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## medicdan (Jul 7, 2010)

I'm sorry to hear you failed your NREMT exam. Consider going back to your textbook to review Oxygen administration. I'm not going to give you the answer, it's important you seek it yourself... if you don't properly understand this, it seems you have bigger problems. Consider the following questions:

1) When you learned CPR, do you use an NRB or a BVM? Why? What do you do with a patient who has a pulse, but is not breathing?
2) What percentage of oxygen does an NRB provide? BVM? 
3) What is a normal respiratory rate for an adult? What do you do if you have a patient above or below that? 
4) What would you do with a conscious patient who is showing signs of cyanosis? 

Consider reviewing your chapter on Airway, Airway Equipment, Resp emergencies and CPR.


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## livewiremaxx (Jul 7, 2010)

BVM is for when you dont have proper respiratory rate or tidal volume.  O2 supplement is good either way 

just my .02 cents could  be wrong though


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## medicdan (Jul 7, 2010)

livewiremaxx said:


> just my .02 cents could  be wrong though






Edit: Post Redacted.


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## livewiremaxx (Jul 7, 2010)

Because I am human and could be wrong.  Everyone precieves and answer differently and a question in its own way.  The way i put it is correct for where I am at, and when i took the test.  however the OP question could have been perceived differently.


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## Melclin (Jul 7, 2010)

This seems to come up a lot. I don't know why, its not that hard to grasp (I'm not having a go at you OP, your education was probably pretty rubbish). 

You need to understand the difference between oxygenation and ventilation. Get googling. Forget your EMT text. 


-An NRBM makes the air you breath have a higher oxygen content. It does not breath for you.
-A BVM breathes for you (it also adds O2 when connected obviously)

If the pt is not breathing, or their chest expansion or breathing rate is wholly insufficient to get enough O2  (even with a high percentage of O2 from an NRBM), then you need to breath for them with a BVM. 

If a person is capable of moving air themselves, they don't need you to breath for them with a BVM. They may still be "short of breath" or need extra oxygen for many different reasons, so then you may consider an NRBM.


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## lampnyter (Jul 7, 2010)

Melclin said:


> If a person is capable of moving air themselves, they don't need you to breath for them with a BVM. They may still be "short of breath" or need extra oxygen for many different reasons, so then you may consider an NRBM.



This is not exactly true. If a pt has a RR of 5 im not going to put them on a NRB but i will bag them. A very basic rule i go by is "under 8, ventilate" but like everything else in the EMS world, this has exceptions. I would also use a BVM if a patient is breathing too fast or is not getting good volume.


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## akflightmedic (Jul 7, 2010)

Lamp...did you miss this part of Melclin's post?

"If the pt is not breathing, or their chest expansion or 

breathing rate is wholly insufficient to get enough O2 (even with a high percentage of O2 from an NRBM), 

then you need to breath for them with a BVM."

I separated it so you do not miss it a second time. (read the middle section)


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## lampnyter (Jul 7, 2010)

akflightmedic said:


> Lamp...did you miss this part of Melclin's post?
> 
> "If the pt is not breathing, or their chest expansion or
> 
> ...



yes but he said if the patient is moving air by themselves that they dont need a BVM.


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## medicdan (Jul 7, 2010)

Despite all of this, I hear some rumors there are going to be changes to CPR guidelines, including use of an OPA and NRB for BLS resus, rather then an OPA and BVM. There certainly are some promising studies supporting it...


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## Melclin (Jul 8, 2010)

lampnyter said:


> yes but he said if the patient is moving air by themselves that they dont need a BVM.



I think its pretty clear. If you take that specific comment out of context, then yeah, its not strictly correct. I'm not writing a legal document after all. "If the patient is moving _enough_ air would be more correct", but I did cover that idea earlier. 



emt.dan said:


> Despite all of this, I hear some rumors there are going to be changes to CPR guidelines, including use of an OPA and NRB for BLS resus, rather then an OPA and BVM. There certainly are some promising studies supporting it...



That's a bit different. As far as I know that's about movement of air caused by the chest compressions. Its the jumping up and down on the chest that causes the movement of air. But the basic principle of oxygenation vs ventilation still holds true. Also I imagine its a BLS thing. I can't imagine that anything is going to replace PPV + intubation as a definitive airway management technique (provided medics are good enough to get the tube without delay, but that's another story), but as always, I'd be happy to be proved wrong.


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## medicdan (Jul 8, 2010)

> That's a bit different. As far as I know that's about movement of air caused by the chest compressions. Its the jumping up and down on the chest that causes the movement of air. But the basic principle of oxygenation vs ventilation still holds true. Also I imagine its a BLS thing. I can't imagine that anything is going to replace PPV + intubation as a definitive airway management technique (provided medics are good enough to get the tube without delay, but that's another story), but as always, I'd be happy to be proved wrong.



Exactly... it would be a BLS only intervention, and based on the principal of gas exchange during chest compressions. New emphasis has been placed on quality, uninterrupted compressions... and lets be serious, basics suck at mask seal and ventilating properly-- without pumping air into the stomach.

See: http://www.ncbi.nlm.nih.gov/pubmed/19660833
http://www.ncbi.nlm.nih.gov/pubmed/17379381

</rant>


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## Meursault (Jul 9, 2010)

Melclin said:


> (provided medics are good enough to get the tube without delay, but that's another story),



And therein lies a lot of the reason for the push towards continuous compressions. 
http://circ.ahajournals.org/cgi/content/full/116/25/2894

The author, GA Ewy, has published a fair amount on the subject in everything from _Circulation_, _Resuscitation_, and _Annals of EM_ to _EMS Responder_. You've probably already read one or more articles of his; this  is just an editorial for everyone's benefit.

There's not much out there explicitly linking CCC CPR and the minimal use of advanced interventions. I wonder if the authors don't want to touch the issue of discouraging intubation.


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## Melclin (Jul 11, 2010)

MrConspiracy said:


> And therein lies a lot of the reason for the push towards continuous compressions.
> http://circ.ahajournals.org/cgi/content/full/116/25/2894
> 
> The author, GA Ewy, has published a fair amount on the subject in everything from _Circulation_, _Resuscitation_, and _Annals of EM_ to _EMS Responder_. You've probably already read one or more articles of his; this  is just an editorial for everyone's benefit.
> ...



I can't see why they would want to discourage it. CCC CPR is predominantly, as is my understanding, about reducing the interuptions to compressions. Intubation has the same affect and provide some protection from aspiration. I can't see it being got rid of. I suppose their is the issue of decreased venous return from PPV, people have to be ventilated at some stage, maybe ITDs will become the norm. 

I'm interested in the idea of tubing the patient quickly without ceasing compressions. I've heard from some that its perfectly possible - and the norm in some places. Not that our clinical standards committee and CSOs discuss these matters with me (pffftt snobs  ), but it doesn't seem like its really even considered here. I've only ever seen MICA pause compressions for tubes, sometimes for far too long...wonder if MelbourneMICA is lurking around to tell me off


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