Oxygen and psychogenic shock

[RedheadErin]

For my final, I am being presented with a number of non-life-threatening but still painful and frightening injury scenarios. (Example, a pencil to the eye, amputated finger, etc) I want to give my pretend patients oxygen as a prophylactic against psychogenic shock. How much do I give?

 

[DrankTheKoolaid]

Not sure if troll......

 

[RedheadErin]

How would that qualify me as a troll? :unsure:It's a reasonable question.

 

[EMT B]

if this is a legitimate question then 2-4 via NC should be fine

 

[RedheadErin]

Thank you. That was what I wanted to know.

 

[Achilles]

if this is a legitimate question then 2-4 via NC should be fine

So we're going to give oxygen just to say we have given oxeygen?

 

[chaz90]

Your pretend patients don't need oxygen. Tell me again what condition requiring oxygen you're treating? A finger laceration does not cause any condition for which oxygen can provide a benefit. Psychogenic shock? Are you referring to syncopal episodes post psychologically traumatic event? These are often vasovagal events that are self correcting. Also, if you're already there you have them sitting or on your stretcher and in no danger of passing out and hurting themselves. Seriously, don't over think this. Not every patient gets oxygen!

 

[VFlutter]

You have asked a few questions about oxygen administration. Oxygen is a medication and like all other medications has a specific indication; hypoxemia. "Prophylactic for psychogenic shock" is not an acceptable indication for supplemental oxygen. Giving oxygen to a patient with normal oxygen saturation is a medication error, plain and simple. Oxygen is not harmless and can cause patients harm in certain situations.

How will supplemental oxygen prevent a syncopal episode? You may want to study more about the pathophysiology of syncope. A P02 of 300 isn't going to help when you lose sympathetic tone...

If you absolutely have to apply oxygen because of a stupid protocol then give them 1L NC. Seriously.

Good article.
http://www.medscape.com/viewarticle/778505_3

 

[Handsome Robb]

15 lpm via non-rebreather.

/thread

 

[STXmedic]

Your pretend patients don't need oxygen. Tell me again what condition requiring oxygen you're treating? A finger laceration does not cause any condition for which oxygen can provide a benefit. Psychogenic shock? Are you referring to syncopal episodes post psychologically traumatic event? These are often vasovagal events that are self correcting. Also, if you're already there you have them sitting or on your stretcher and in no danger of passing out and hurting themselves. Seriously, don't over think this. Not every patient gets oxygen!

This.

You have asked a few questions about oxygen administration. Oxygen is a medication and like all other medications has a specific indication; hypoxemia. "Prophylactic for psychogenic shock" is not an acceptable indication for supplemental oxygen. Giving oxygen to a patient with normal oxygen saturation is a medication error, plain and simple. Oxygen is not harmless and can cause patients harm in certain situations.

How will supplemental oxygen prevent a syncopal episode? You may want to study more about the pathophysiology of syncope. A P02 of 300 isn't going to help when you lose sympathetic tone...

If you absolutely have to apply oxygen because of a stupid protocol then give them 1L NC. Seriously.

Good article.
http://www.medscape.com/viewarticle/778505_3

And this.

15 lpm via non-rebreather.

/thread

This should be grounds for the ban hammer.

 

[Aprz]

It says he's a student. Y'know his instructors are probably veteran medics saying "you can never go wrong with oxygen; it's benign." On this foum, I know oxygen is a huge issue, but I think it's not as bad as we make it sound. In my opinion, it's mininally harmful in MIs and strokes. It can be very harmful to administer to neonates if excessive, paraquat poisoning, high dose over many hours, and in cardiac arrest if excessive. It's not beneficial for a lot of things we give it for in EMS, but it can lead to a poor outcome if not given when needed/indicated (just like any other meds).

OP, search the foumd in regard to oxygen administration, it's been discussed to death. Also search the web like Dr. Bledsoe, I believe it has mentioned on ems12lead, both EMS1 and JEMS had an article on it. Look up reperfusion injury and free radicals. Oxygen is not as benign as once though, but I don't think it's that bad either. Many medical professionals (especially EMS) are still behind the tines on it.

 

[RedheadErin]

Y'know his instructors are probably veteran medics saying "you can never go wrong with oxygen; it's benign."

Yep. That is my problem exactly. I have to prepare myself for something like 60 possible scenarios. The instructor likes to think up anything and everything that might happen/be considered/ever be imagined, so I want to be ready. If he says "YOur patient is in horrible pain because he cut off 3 of his fingers with a circular saw. He may faint," I need to know what to say to that. Telling the patient to man up isn't going to be the answer!

 

[STXmedic]

Yep. That is my problem exactly. I have to prepare myself for something like 60 possible scenarios. The instructor likes to think up anything and everything that might happen/be considered/ever be imagined, so I want to be ready. If he says "YOur patient is in horrible pain because he cut off 3 of his fingers with a circular saw. He may faint," I need to know what to say to that. Telling the patient to man up isn't going to be the answer!

You may have some insane amount of possible scenarios your instructor can give you, but as a basic there are only so many things you can do. If they're bleeding, stop it. Extremity injury? Don't let them move it. If they aren't breathing, breathe for them. No heart beat? Move blood for them. Your patients hypoxic? Give them oxygen. Unsure what to do? Drive fast. I think you may be over-thinking this a bit.

 

[Aprz]

Yep. That is my problem exactly. I have to prepare myself for something like 60 possible scenarios. The instructor likes to think up anything and everything that might happen/be considered/ever be imagined, so I want to be ready. If he says "YOur patient is in horrible pain because he cut off 3 of his fingers with a circular saw. He may faint," I need to know what to say to that. Telling the patient to man up isn't going to be the answer!

I think you misunderstood what I was saying in that setence you quoted. I was kindly saying your instructors are wrong, if they are saying that about oxygen, but to give you a break since you're a student. Students and new EMTs response to us when we say their instructor is wrong often is "but my instructor has been a fire/medic for 15 years! He is one helluva a medic!" Your instructors are credible, but credibility doesn't make you right.

I agree with STXmedic, there isn't much you can do. The NREMT expects you to follow an algorithm. No matter what, you will consider administering oxygen during the inital assessment, or when needed if the patient's condition changes which requires you to reevaluate ABC, or when needed. Typically their pattern is little sick gets low flow; big sick, MI, shortness of breath, stroke, and shock gets high flow. I disagree with this, but that's close to the algorithm. The rationale, which I disagree with, is that the oxygen will help your body compensating mechanisms (since you will be burning through oxygen quicker). Again, I disagree with this, but that's what the NREMT wants to hear from ya.

 

[IslandTime]

Are we overlooking the placebo effect. I'm really new to this, an FF Probie in a combined department who will be continuing to EMT-B next year. We run aid calls to assist the EMTs and paramedics. On one run I watched with fascination as an end-tidal was placed on a patient with breathing difficulties and the symptoms eased... except the oxygen port wasn't hooked up to anything. Don't forget that the mind is a very powerful instrument.

 

[RedheadErin]

I agree with you. I was a medic in the national Guard and I was an ER Tech a long time ago, and I don't always think he is right. But this week, he is the person who determines whether I am going to sit for the National or go back and do this class again. So yeah, until Thursday, if he says the sun rises in the West, that had better be OK with me.

I just want to know a simple thing. I have about 5 scenarios where somebody has had something horribly painful and frightening but medically minor happen to them. It is feasible that the instructor will say "even though he has not lost a lot of blood, he is pale, cool, and diaphoretic. He says he feels faint. What are you going to do?" I just want to know a reasonable response to that question.

 

[VFlutter]

What are you going to do?" I just want to know a reasonable response to that question.

Well, what would you do? We are not going to just give you an answer

 

[Jambi]

Are we overlooking the placebo effect. I'm really new to this, an FF Probie in a combined department who will be continuing to EMT-B next year. We run aid calls to assist the EMTs and paramedics. On one run I watched with fascination as an end-tidal was placed on a patient with breathing difficulties and the symptoms eased... except the oxygen port wasn't hooked up to anything. Don't forget that the mind is a very powerful instrument.

This is malpractice and this mind set is part of the reason we get students on here asking these sorts of questions. Before accepting this as a reasonable thing to do find anything about utilizing a drug or device to leverage the "placebo" effect. Find one protocol mentioning it, one EMS medical director advocating it, or a CE course training on it.

I'm not calling you out for this, but rather the practice and acceptance of it. I despise lying to patients, and this is essentially lying.

 

[chaz90]

This is malpractice and this mind set is part of the reason we get students on here asking these sorts of questions. Before accepting this as a reasonable thing to do find anything about utilizing a drug or device to leverage the "placebo" effect. Find one protocol mentioning it, one EMS medical director advocating it, or a CE course training on it.

I'm not calling you out for this, but rather the practice and acceptance of it. I despise lying to patients, and this is essentially lying.

They weren't necessarily going for a placebo effect. I feel like I mention this too often on here, but I routinely place capnography cannulas on patients who are having a panic attack. I don't attach the oxygen tubing to anything, and I don't tell the patient I'm giving them any oxygen. I show them how low their "yellow CO2 number" is, explain why it's low, and coach them to slow their breathing as they watch it rise to what it should be.

 

[RedheadErin]

The NREMT expects you to follow an algorithm. No matter what, you will consider administering oxygen during the inital assessment, or when needed if the patient's condition changes which requires you to reevaluate ABC, or when needed. Typically their pattern is little sick gets low flow; big sick, MI, shortness of breath, stroke, and shock gets high flow. I disagree with this, but that's close to the algorithm. The rationale, which I disagree with, is that the oxygen will help your body compensating mechanisms (since you will be burning through oxygen quicker). Again, I disagree with this, but that's what the NREMT wants to hear from ya.

I missed this when I wrote the last reply. THAT is exactly what I needed to know.

What would I do? If he is P, C, & D, I would put him in Trendelenburg's Position, give him a blanket, and give some O2. Since his problem in these scenarios is relatively minor, I would give low-flow O2, but this is the part I was not sure about. The book just says "give oxygen."