Acute coronary syndrome /MI/STEMI and Oxygen administration

VentMonkey said:
I don’t think my remark is quite the same as a pain management comparison, and perhaps it was simply completely misconstrued on your behalf after it struck a nerve; fair enough, no harm, no foul.
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Quite possible. In practice, I'm sure we're both advocating the same thing.
 
If it helps the dyspnea, based on experience, I'd say its fine, but the book does say that O2 is not beneficial for a PT you just talked about, however, does it provide comfort at times? Yes. So again if in resp. Distress, depending on its severity, I'd say it is fine if not and the pt has no sign of SOB or resp. Distress then low dosage or nothing would probably make little to no difference.
 
The thing about hyperoxemia is that it produces a lot free radicals which actually do a lot of harm by overdosing on oxygen and cells won't regenerate properly. That being said, generally speaking cells do regenerate faster in a hyperoxic environment like certain traumas like pneumo's. The cells at the breach that prompt the pneumo in the first place with regenerate in a hyperoxic environment. Which is why some physicians will keep them on NRM for several days regardless of SpO2. But it is a benefit versus risk thing left up to those with MD behind their names. So maintaining SpO2's 94% and higher on minimal supplemental oxygen will do just fine.

So everyone says >/= 94%. How can you tell if you're actually maintaining that? Officially you can't. But you can have a good idea if your machine is telling you the truth or lying to you. The best way is if your pulse oximeter has a plethysmograph. If you do have one of these then your machine is being as honest with you as it possibly can. If you don't then it is lying to you regardless of what your sat reads. Don'e believe it. That's when you will have to treat clinically.

Now as far as "high flow O2" goes. I am an old school respiratory therapist. And I fundamentally and adamantly disagree with National Registry as to what "high flow oxygen" is.

So treat your patient. If you treat mechanically know when your machine is lying to you. If you treat clinically then treat clinically.
 
MSDeltaFlt said:
The best way is if your pulse oximeter has a plethysmograph. If you do have one of these then your machine is being as honest with you as it possibly can. If you don't then it is lying to you regardless of what your sat reads. Don'e believe it. That's when you will have to treat clinically.
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So if you have a pleth, the sat is accurate, but if you don’t have a pleth, the same exact technology is innacurate?

Modern pulse oximeters are actually very precise.
 
MSDeltaFlt said:
The thing about hyperoxemia is that it produces a lot free radicals which actually do a lot of harm by overdosing on oxygen and cells won't regenerate properly. That being said, generally speaking cells do regenerate faster in a hyperoxic environment like certain traumas like pneumo's. The cells at the breach that prompt the pneumo in the first place with regenerate in a hyperoxic environment. Which is why some physicians will keep them on NRM for several days regardless of SpO2. But it is a benefit versus risk thing left up to those with MD behind their names. So maintaining SpO2's 94% and higher on minimal supplemental oxygen will do just fine.

So everyone says >/= 94%. How can you tell if you're actually maintaining that? Officially you can't. But you can have a good idea if your machine is telling you the truth or lying to you. The best way is if your pulse oximeter has a plethysmograph. If you do have one of these then your machine is being as honest with you as it possibly can. If you don't then it is lying to you regardless of what your sat reads. Don'e believe it. That's when you will have to treat clinically.

Now as far as "high flow O2" goes. I am an old school respiratory therapist. And I fundamentally and adamantly disagree with National Registry as to what "high flow oxygen" is.

So treat your patient. If you treat mechanically know when your machine is lying to you. If you treat clinically then treat clinically.
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Treat clinically. As in correlating the diagnostic readings you get to your patient's condition? Sometimes (*gasp*) we use a lil finger tip pulse oximeter. It is much lighter than the lifepak when walking in the woods. Or sometimes there or are multiple patients. I could go on. But really, why exactly would I assume the pulse ox is "lying" with it reads 94% with a patient who is not dyspneic or tachycardic and has skin that is well-perfused, warm, and dry along with being eupneic, non-anxious, and with clear lung sounds?

You can't spout things about "treating clinically" and then not have it the other way.
 
Remi said:
So if you have a pleth, the sat is accurate, but if you don’t have a pleth, the same exact technology is innacurate?

Modern pulse oximeters are actually very precise.
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Yes. In the absence of a saw tooth waveform with a dicrotic notch, that number (whatever that number is) is wrong. Period.
 
Tigger said:
Treat clinically. As in correlating the diagnostic readings you get to your patient's condition? Sometimes (*gasp*) we use a lil finger tip pulse oximeter. It is much lighter than the lifepak when walking in the woods. Or sometimes there or are multiple patients. I could go on. But really, why exactly would I assume the pulse ox is "lying" with it reads 94% with a patient who is not dyspneic or tachycardic and has skin that is well-perfused, warm, and dry along with being eupneic, non-anxious, and with clear lung sounds?

You can't spout things about "treating clinically" and then not have it the other way.
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You always treat clinically. You take the data you are given with a grain of salt. As a clinician you physically assess your patient. You put your hands on them and feel their skin. You look at their mucosa. You listen to their lungs. You ask them questions. You look around you. You gather all kinds of data including the data your machine(s) give you and you, as a clinician, interpret said data. Is your machine's data coinciding with your patient's complaint and physical findings? Is it not coinciding?

This isn't rocket science. IF you use a machine then you HAVE to interpret the data as accurate or inaccurate. Otherwise you run the risk of becoming a V.O.M.I.T. medic. Something I believe the OP is trying NOT to be.
 
MSDeltaFlt said:
You always treat clinically. You take the data you are given with a grain of salt. As a clinician you physically assess your patient. You put your hands on them and feel their skin. You look at their mucosa. You listen to their lungs. You ask them questions. You look around you. You gather all kinds of data including the data your machine(s) give you and you, as a clinician, interpret said data. Is your machine's data coinciding with your patient's complaint and physical findings? Is it not coinciding?

This isn't rocket science. IF you use a machine then you HAVE to interpret the data as accurate or inaccurate. Otherwise you run the risk of becoming a V.O.M.I.T. medic. Something I believe the OP is trying NOT to be.
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So if the data coincides with the patient's presentation but there is no pleth wave available, the data is still wrong?
 
MSDeltaFlt said:
es. In the absence of a saw tooth waveform with a dicrotic notch, that number (whatever that number is) is wrong. Period.
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To state without further evidence that its categorically wrong (IMHO) is a bit incorrect. I would suggest "suspect" as a more appropriate term, as it includes possible errors from the device as well as the user.
 
I literally just passed my practicals and I was scared to death I'd failed it because I did NOT admin 02 on a non hypoxic pt with acute MI and said why I wasn't doing it.... My proctor told me after that he was impressed that I didn't and knew why even though this wasn't a critical fail. ON MY WHOPPING 100 hours an ambulance with multiple Mi' s not a one has been put on 02. If it ain't broke, don't fix it, comes to mind
 
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