Speaking of oxygenation and ventilation, isn't the newest research showing that we should be guiding our ventilatory rate by keeping the EtCO2 WNL and keeping SpO2 between 95-99%?
Hyperventilation is out, and depending on the nature of the illness excessive O2 is actually harming patients. Free radicals (O2 ions) are being shown to attack sites of ischemia in MI and CVA patients. Even for TBI with suspected herniation you're still only supposed to allow for permissive hyperventilation maintaining an EtCO2 between 30-35... Closer to 30.
And even that, according to a Trauma Intensivist I spoke to a few weeks ago is showing not to be very beneficial to patient outcome.
For medical it is even being shown that high flow isn't even necessary, 2-4Lpm via NC is all you really need to maintain adequate oxygenation in a breathing patient with good TV; provided no V/Q mismatch mechanism is present or evident. Obviously, circumstances may be unique and other interventions may be required.
Obviously, this is ground breaking research as we were all taught O2, O2, O2 all day, everyday as youngsters. We're all aware of EMS being a very fluid environment with things changing and providers adapting as our science and technology evolve to beat out the things we do because we've just always done them.
I don't debate that O2 is crucial in an arrest, but the reserve of unused O2 in circulation is one reason why "hands only" is the new standard. The public doesn't want to be putting their mouth on other people who are "dead." Thus, the AHA concluded it was better for them to do something beneficial until advanced providers arrived. The study and reasoning, as it was explained to me by the AHA education coordinator for my region, was that the goal of "hands only" was to use that O2 reserve in the blood to feed the coronary arteries during diastole, and to help perfuse the brain while EMS is on the way. It increases the "salvagability" of the patient even without oxygenation so that when we arrive, we actually have a better fighting chance at getting a "save" provided we get to the patient within 8-15 minutes (more or less.)
Granted, it is debatable as some would say it is better to do "this or that" than be dead. But the goal of a true "save" is to prevent death OR debilitating injury so that a patient is discharged home to the same or near the same quality of life they had prior to the event. Not to just get pulses back in the ED, and create a new customer for some awful SNF. Maitaining adequate respiration and circulation (uninterrupted compressions) is critical in obtaining that result.
Sorry, I kind of went off on some tangents, but ... Yeah...there it is.
