NRB over NC

[Bullets]

not you regular NC v NRB question. I am at my squad and one of my fellow EMT's said he got in a discussion with another EMT and he was told that as Basics, if we put patients on a NC instead of a NRB we are making a diagnosis and thats not allowed. He says we were only taught to put on a NC if the pt couldnt tolerate the NRB. I dont have my EMT book nearby so i cant look this up, but it doesnt seem right. Thoughts, opinions?

 

[JPINFV]

not you regular NC v NRB question. I am at my squad and one of my fellow EMT's said he got in a discussion with another EMT and he was told that as Basics, if we put patients on a NC instead of a NRB we are making a diagnosis and thats not allowed. He says we were only taught to put on a NC if the pt couldnt tolerate the NRB. I dont have my EMT book nearby so i cant look this up, but it doesnt seem right. Thoughts, opinions?

Thoughts?

NRB is what is taught, what is in the books, and what is on the test. EMTs are taught that they don't make diagnosis.

Both, independent of each other, makes for terrible patient care. If you don't make a diagnosis, what exactly are you treating?

Everyone gets a non-rebreather mask makes as much sense as everyone is transported with lights and sirens.

 

[Anjel]

I in working and on my paramedic clinicals have never placed or seen a NRB.

I have placed a pt on a NC quiet a few times though.

For testing purposes yes NRB all the way. Real life... TREAT YOUR PT

 

[LucidResq]

How is providing appropriate care based on the situation "making a diagnosis" or wrong?

That is pretty much the silliest thing I've ever heard. There are many instances in which a NC is very appropriate. They make it much easier to get a good history, for example.

 

[Shishkabob]

Next time someone tells you an EMT or Paramedic don't diagnose, ask them what they would call angulated bones sticking out of a leg... and if they say it's broken tell them they just diagnosed.

I sure as hell HOPE you diagnose someone with something every time you go to give a drug... otherwise you're just giving a drug blidnly which is stupid.





I can count on one hand the amount of patients I've put on an NRB in the past year... and each one ended up getting intubated.

 

[Bullets]

Thats pretty much what i said. if you decide to put a patient on a NRB, isnt that a diagnosis? and the whole high flow for everyone is bad pt care. Thanks guys

 

[MrBrown]

As Ambulance Officers it is required both provisional and differential diagnoses be made.

98% of people will not require oxygen, and of the 2% that those that 1.9% will require like two litres on an NC

 

[Amycus]

For testing purposes, NRB on everyone.

In real life, the only ones that get it are those in SEVERE distress. Blatent hypoxia, unresponsiveness, asthma (although we can do BLS albuterol), etc. etc.

In the CAOx4 chest pain/lightheadedness/minor respiratory distress/diabetic etc, they get a NC every time.

 

[Frozennoodle]

In my basic class I was taught to treat the patient, the different stages of shock, the signs of hypoxia, and how to titrate oxygen to effect. MI? I was told to consider supplemental O2 but not to over due it if the patient was profusing because oxygen can be detrimental to some types of cardiac events and you didn't have the tools or knowledge to identify them. I was showed the difference between situations where high flow O2 was required and where 2LPM would be a better option. I was taught to think. I don't understand how people can teach cookbook medicine and no one have a problem with it. My instructors are huge on understanding pathology and A&P and constantly challenge us to think about eitologies and what physiological processes cause the symptoms we are treating. If we have a question about the way something works they challenge us to try and figure it out on our own before explaining how it works. These schools are trash.

 

[Anjel]

In my basic class I was taught to treat the patient, the different stages of shock, the signs of hypoxia, and how to titrate oxygen to effect. MI? I was told to consider supplemental O2 but not to over due it if the patient was profusing because oxygen can be detrimental to some types of cardiac events and you didn't have the tools or knowledge to identify them. I was showed the difference between situations where high flow O2 was required and where 2LPM would be a better option. I was taught to think. I don't understand how people can teach cookbook medicine and no one have a problem with it. My instructors are huge on understanding pathology and A&P and constantly challenge us to think about eitologies and what physiological processes cause the symptoms we are treating. If we have a question about the way something works they challenge us to try and figure it out on our own before explaining how it works. These schools are trash.

Good post.

I want those people that are always saying "well the book says" to show me a pt that has ever presented EXACTLY like the book says. It isn't a perfect world folks.

 

[DesertMedic66]

Next time someone tells you an EMT or Paramedic don't diagnose, ask them what they would call angulated bones sticking out of a leg... and if they say it's broken tell them they just diagnosed.

I sure as hell HOPE you diagnose someone with something every time you go to give a drug... otherwise you're just giving a drug blidnly which is stupid.





I can count on one hand the amount of patients I've put on an NRB in the past year... and each one ended up getting intubated.

That's the thing I hate. We actually have to say it's a "possible open fracture". I understand not diagnosing somethings. But if it's completely odvious then we should be able to "diagnose". Had a femer fracture the other day with deformity (obviously fractured) but still had to call it in to the hospital as a "possible fracture". :glare:

 

[DrParasite]

I in working and on my paramedic clinicals have never placed or seen a NRB.

I have placed a pt on a NC quiet a few times though.

For testing purposes yes NRB all the way. Real life... TREAT YOUR PT

ummm, how long have you been in EMS? 6 months? a year maybe? Are you taking a "Zero to Hero" paramedic program?

I probably have put on more NRB's than I should have in my career. but if you are in your paramedic clinicals, and have never ever put a patient on an NRB? never had a bad diff breather? never had a lady with a pulse ox of 80 (and who was turning blue)? or an asthmatic who you gave an NRB with a Neb treatment?

If you haven't, than wow.

BTW, the book does say NRB for everyone. I don't agree with it, but that is the standard of care for BLS (or rather, the educated standard). and you have documentation to support it as well. I don't agree with it, it is over kill, but that will be the standard you are both taught to and will be held to if you are asked to defend your actions.

 

[usafmedic45]

not you regular NC v NRB question. I am at my squad and one of my fellow EMT's said he got in a discussion with another EMT and he was told that as Basics, if we put patients on a NC instead of a NRB we are making a diagnosis and thats not allowed. He says we were only taught to put on a NC if the pt couldnt tolerate the NRB. I dont have my EMT book nearby so i cant look this up, but it doesnt seem right. Thoughts, opinions?

You mean beyond the fact that your fellow EMT is a :censored::censored::censored::censored:ing retard?

 

[usafmedic45]

but that will be the standard you are both taught to and will be held to if you are asked to defend your actions.

Well, more likely they would pull out the local protocols since that's the standard you are supposed to be practicing to, not some half-baked national "standard". Just my two cents as an expert witness. If they were going after the medical director and they had a very low quality attorney, they might try to trot that out the EMS textbook to inquire why the protocols aren't matching the aforementioned "standard".

 

[systemet]

I can count on one hand the amount of patients I've put on an NRB in the past year... and each one ended up getting intubated.

And this is one of the major reasons to use a NRB. It's a good device for providing a high FiO2, if you're preoxygenating a patient in preparation for RSI / sedation-facilitated intubation, or if you have some reason to expect they're going to suddenly become apneic.

As far as I see it, the other is in the presence of clinical signs of hypoxia when a nasal cannula is not raising the SpO2 and bringing relief.

 

[Bullets]

You mean beyond the fact that your fellow EMT is a :censored::censored::censored::censored:ing retard?

that's what I said, but he challenged me to prove it

 

[usafmedic45]

that's what I said, but he challenged me to prove it

That's when you respond with, "Ah, I see you believe in the scientific principle of reproducibility. Excellent!"

 

[nwhitney]

We were taught in class that everyone gets O2. When I did my ride along I learned that while it was a lot like the text book it was also nothing like the book. Not everyone got O2, I think of the 9 pt's we had only 3 got O2 and of those 3 only 1 got a NRB. Even it the pt's O2 is at 100% on room air couldn't giving them O2 help or at least make them think they are getting help? The placebo effect?

 

[usafmedic45]

We were taught in class that everyone gets O2.

You were taught wrong.

Even it the pt's O2 is at 100% on room air couldn't giving them O2 help or at least make them think they are getting help? The placebo effect?

Do a search about the strong negative effects of oxygen therapy and you'll see what that's not a good idea. It's actually been documented to increase mortality in some patient populations when used in absence of clinically demonstrable hypoxia.

 

[nwhitney]

You were taught wrong.



Do a search about the strong negative effects of oxygen therapy and you'll see what that's not a good idea. It's actually been documented to increase mortality in some patient populations when used in absence of clinically demonstrable hypoxia.

Our text book has us giving everyone O2 unless I read it wrong which may have happened.

I've heard that O2 therapy over a period of time (not sure how lung) can have negative affects but I thought short term use (during transport) was not as a big concern. Sounds like I got some research to do. Thanks for the info I find respiratory therapy fascinating.