Any comments on this one......

[EMS49393]

That's not an actual study, that's just some note for nurses. You have to back up your information with facts, something that EMS is fricken horrible at doing.

And another thing, since you can take a flame, Stop being a doormat!

I clean up after myself. I don't trash ambulances or drop crap on the floor if I can help it. If all defecation hits the rotary oscillator, there might be a mess, and I'll at least help clean it up.

It pisses me off that there are still lazy, archaic, knuckle-dragging medics out there that think everyone should clean up after them and be silent. How the hell are you supposed to learn if you're quiet on calls? Nevermind, you'll likely just get the same backwards 1972 answers paramedics just can't seem stop using.

 

[emt seeking first job]

That's not an actual study, that's just some note for nurses. You have to back up your information with facts, something that EMS is fricken horrible at doing.

And another thing, since you can take a flame, Stop being a doormat!

I clean up after myself. I don't trash ambulances or drop crap on the floor if I can help it. If all defecation hits the rotary oscillator, there might be a mess, and I'll at least help clean it up.

It pisses me off that there are still lazy, archaic, knuckle-dragging medics out there that think everyone should clean up after them and be silent. How the hell are you supposed to learn if you're quiet on calls? Nevermind, you'll likely just get the same backwards 1972 answers paramedics just can't seem stop using.

Once again, they do not ask me. I just do it.

If they did tell me, I just might as soon not do it....

 

[Shishkabob]

So the answer is o2 is not always medically indicated even while it is not harmful.

Who said O2 is not harmful?

The unwritten rule at my service is the newer person cleans up. People with a higher # with me, I always ensure they do it.

Your agency has too many stupid unwritten rules.

Everyone cleans the rig, regardless of length at agency or certificaion level. I have no problems cleaning the mess I made.

 

[JPINFV]

Small study in Norway looking at supplemental oxygen in stroke patients. If you read the discussion, note that one confounding variable is that some patients in the non-oxygen group received it prehospitally before being split into a cohort.

Background and Purpose—We sought to test the hypothesis that breathing 100% oxygen for the first 24 hours after an acute stroke would not reduce mortality, impairment, or disability.

Methods—Subjects admitted to the Central Hospital of Akershus, Norway, with stroke onset <24 hours before admittance were allocated to 2 groups by a quasi-randomized design using birth numbers. All patients with acute stroke admitted to hospital within 24 hours after a stroke were included and enrolled. Patients were allocated to a group that received supplemental oxygen treatment (100% atmospheres, 3 L/min) for 24 hours (n=292) or to the control group, which did not receive additional oxygen. Main outcome measures were 1-year survival, neurological impairment (Scandinavian Stroke Scale), and disability (Barthel Index) 7 months after stroke.

Results—One-year survival was 69% in the oxygen group and 73% in the control group (OR 0.82; 95% CI 0.57 to 1.19; P=0.30). Impairment scores and disability scores were comparable 7 months after stroke. Among patients with Scandinavian Stroke Scale (SSS) scores of >=40, 82% in the oxygen group and 91% in the control group survived (OR 0.45; 95% CI 0.23 to 0.90; P=0.023). For patients with SSS scores of <40, 53% in the oxygen group and 48% in the control group survived (OR 1.26; 95% CI 0.76 to 2.09; P=0.54).

Conclusions—Supplemental oxygen should not routinely be given to nonhypoxic stroke victims with minor or moderate strokes. Further research is needed to give conclusive advice concerning oxygen supplementation for patients with severe strokes.

http://stroke.ahajournals.org/cgi/content/full/strokeaha;30/10/2033


Markers for oxidative stress in non-hypoxic volunteers:

Abstract

Supplemental oxygen is often administered to induce hyperoxia in nonhypoxic patients for indications such as chest pain, despite lack of evidence of clinical benefit. Induced hyperoxia is potentially toxic, since it may increase oxidative stress and peroxidative damage to deoxyribonucleic acid, lipids and proteins.

The aim of this study was to establish whether supplemental oxygen induces oxidative stress in nonhypoxic subjects.

Breath markers of oxidative stress were measured in 31 healthy subjects before and after breathing 28% oxygen at 2.0 L·min−1 via nasal prongs for 30 min while resting. The criterion standard of oxidative stress was the breath methylated alkane contour (BMAC), a three-dimensional plot of the alveolar gradients of C4–C20 alkanes and monomethylated alkanes produced by lipid peroxidation. Volatile organic compounds (VOCs) in breath were assayed by gas chromatography and mass spectroscopy, and the BMACs before and after oxygenation were compared.

Following oxygenation, there was a significant increase in mean volume under the curve of the BMAC and in alveolar gradients of three VOCs: 3‐methyltridecane, 3‐methylundecane and 5-methylnonane.

Breath markers of oxidative stress were significantly increased in normal volunteers breathing supplemental oxygen for 30 min.

http://erj.ersjournals.com/content/21/1/48.full

 

[the_negro_puppy]

Study done in Australia, published in the British Medical Journey

Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial

http://www.bmj.com/content/341/bmj.c5462.full

Conclusions Titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory acidosis compared with high flow oxygen in acute exacerbations of chronic obstructive pulmonary disease. These results provide strong evidence to recommend the routine use of titrated oxygen treatment in patients with breathlessness and a history or clinical likelihood of chronic obstructive pulmonary disease in the prehospital setting.

 

[emt seeking first job]

Thank you for the links.

I am reading them all.

Thank you for the information.

 

[Bullets]

man, dont clean up after the medics, its their mess, they clean it up. Ive been know to leave a bag full of their trash hanging on their door when they leave their stuff behind, just cause they are medics doesnt make them better people, just more educated providers. just like i dont expect medics to check the hopsitals cage for our LSBs and such

Also, 02 is not needed, and if the medics give you hell for it, expalin why it wasnt needed. and definatley not NRB, MAYBE a NC on like 4L. I rarely use the NRB anymore after i took the time to read up on oxygen delivery. I makes me wish we had more pharmacology in EMTB school

 

[firetender]

Just wondering...

Isn't the administration of O2 all about start as low as you can get away with and then titrate to effect? Are you saying some of you automatically slap on a pre-determined flow SEPARATE from the immediate symptoms of the patient?

 

[JPINFV]

Are you saying some of you automatically slap on a pre-determined flow SEPARATE from the immediate symptoms of the patient?

Unfortunately, that is what is taught. NRBs for EVERYONE!

 

[Sasha]

http://nursingcrib.com/nursing-notes-reviewer/oxygen-therapy/

It's really OK, I am very thick skinned. Flame away.

I enjoy reading any response on this forum, even the opinions, right, worng or indifferent it is all good.

I respect every one's opinon here, however, when someone in my service senior to me directs me to put the patient on o2, or any lawful request that does not violate REMSCO protocols, I am gonna follow it without question.

Especially if it makes the patient alert and less depressed.

So flame away, and link up some good meme's.......

:wacko::wacko::wacko::wacko:

:unsure:B):unsure:B):unsure:B):unsure:B):unsure:B):unsure:B)

That's silly. Don't follow without question when someone else is not being a patient advocate. You're doing patients a disservice.

Where does it say the patient is less alert or depressed? I don't remember reading that in the OP (and I harbor a guess that half the crap in that picture is BS)

We don't do things because of unwritten rules, we do things because it benefits the patient. Oxygen did not benefit the patient, a hospital would have benefited the patient. Instead of getting his family to gang up on him and force him on oxygen while waiting for ALS, you should have put him on the stretcher and taken the man to the hospital instead of delaying definitive care.

He wasn't ill informed or senile, he was just not buying the BS!

 

[Handsome Robb]

I understand the 'rookie' aspect of cleaning up, I am a rookie at my service. But there is a place and time for it, if someone makes a huge mess it's there responsibility. As for more educated providers, technically I am the highest educated provider at my service besides a few of our vollies who are around 1 or 2 weekends a year. I am an I everyone else is a B. It doesn't make me any better than the rest of them...

 

[jjesusfreak01]

I understand the 'rookie' aspect of cleaning up, I am a rookie at my service. But there is a place and time for it, if someone makes a huge mess it's there responsibility. As for more educated providers, technically I am the highest educated provider at my service besides a few of our vollies who are around 1 or 2 weekends a year. I am an I everyone else is a B. It doesn't make me any better than the rest of them...

Man, medics must hate running codes in your service if no one helps clean up.

 

[fast65]

In certain instances we do our assesment with the o2 on and as I said, as a service we are trying to either load an go and play on the way rather than stay and play. The hospital is a five minute ride and the patient really needs to be assesed by the ER staff more than us.

The patient in this thread, our crew chief did not want to move him because of the bradycardia.

Well I can assume you went through your ABC's, so when you got to breathing, was there anything at all that indicated the patient needed oxygen? From what I've read, the answer is no.

Why was he afraid to move the patient because of the bradycardia?

 

[Aidey]

Man, medics must hate running codes in your service if no one helps clean up.

I think it is the difference between a disaster and a mess. If you routinely leave the ambulance a disaster, and make no attempt to even pretend to contain or clean up the mess, be prepared to clean up after yourself. If you make a mess, but try and pile all the garbage together, and minimize the gross contamination people are going to be more willing to help you clean up.

I try and minimize my messes when possible. At the very least I try and pile all the garbage in one or two spots. Often if we are at the hospital when someone comes in with a code or other nasty call we will start cleaning up their bus while they drop the patient. I am much more willing to clean up another person's ambulance if I can tell it was clean before and it isn't disgusting.

 

[emt seeking first job]

Why was he afraid to move the patient because of the bradycardia?

They were afraid his heart would stop beating if we did not maintain him in a supine position and since medics are available and in about 5 min, and the potential unstability of the patient, our crew chief deemed it an ALS job.

 

[Shishkabob]

They were afraid his heart would stop beating if we did not maintain him in a supine position

Errrmmm...positional hypotension? Did he do positional blood pressure readings or anything that would indicate his fear as, well... rational?

 

[emt seeking first job]

Errrmmm...positional hypotension? Did he do positional blood pressure readings or anything that would indicate his fear as, well... rational?

Patient's wife reported gross variations in blood pressure the entire day.

We took six reading, within 10 minutes we had a wide range as well.

 

[EMS49393]

They were afraid his heart would stop beating if we did not maintain him in a supine position and since medics are available and in about 5 min, and the potential unstability of the patient, our crew chief deemed it an ALS job.

You couldn't roll a transfer sheet under him and lift him on the stretcher? Please, please tell me you all moved him to the stretcher and not that the magical paramedics had him "turn and pivot" or walk to the stretcher.

 

[MrBrown]

They were afraid his heart would stop beating if we did not maintain him in a supine position and since medics are available and in about 5 min, and the potential unstability of the patient, our crew chief deemed it an ALS job.

Its things like this that make Brown a very worried Brown :unsure:

 

[Handsome Robb]

Man, medics must hate running codes in your service if no one helps clean up.

I'm not saying I wont help clean up. But If a medic runs a code and leaves a huge mess around and doesn't help clean it up, unless they are providing continued patient care, you can count on it that I am going to say something. I wont just leave a mess around, especially since I work outdoors and am environmentally minded, but I'm not gonna clean up after someone just because they are a medic and I am an EMT, I'm not a janitor...