allergic reaction or anxiety attack???

[addictedforever]

Seek out chemistry, A&P, nursing and physician level text if you want to learn about medicine.

This is exactly the reason I pore over my dad's nursing school textbooks, his medical dictionaries, the drug handbook, etc. To learn all I can about this subject.

 

[Handsome Rob]

Actually... the reason I didn't spell out the research was because it has already been stated numerous times before on the forum AND I was in the middle of doing something else which didn't permit me to type a long reply with the research.

I don't always have someone hand feed me the information... I look it up for myself so I suggest you do the same.

I'll at least give you a head start on your research:

- CVA: AHA recommends mild-moderate CVA patients receive only room air. Evidence suggests better outcomes than when these patients receive oxygen.

- MI: Research dating back to the 1950's and recently validated in the 2000's show worsened myocardial ischemia, decreased cardiac output, narrowing of the coronary vessels, and no benefit with oxygen administration. Most MI patients are oxygenating just fine systemically. Oxygen administration has been proven to NOT increase oxygen delivery or reduce tissue death on the other side of the coronary occulsion.

- Neonatal Resuscitation: The NRP program guidelines were changed to reflect neonatal resuscitation to initially begin with room air only. This is something Europe has been doing forever. The US has been about the only one who insisted on using oxygen. Research shows decreased time to first breath, first cry, and overall better outcomes.

- ROSC: Oxidative damage as a result of the re-perfusion sends cells to their ultimate death and not restoration as you would think. Research here is ongoing but much evidence suggests minimal O2 titrated to saturation above 94%.

PA protocols specifically address the new evidence regarding oxygen administration and state to TITRATE OXYGEN ADMINISTRATION to patient needs. It is defined as an SpO2 above 94% and NOT high-flow.

Under neonatal resuscitation protocol it is also further broken down. A neonate does not present with an SpO2 in the typical normal range. If you check their saturation immediately after birth you will see 60% range, 70% range, etc until their body transitions to the extrauterine circulation.

The reason the SpO2 is broken down is so providers do not administer oxygen unnecessarily to these babies because of the negative effects and that it serves no purpose.

I have also read research that found COPD patients should have their oxygen saturation titrated to right around their baseline and not 100%. And no... this has nothing to do with that hypoxic drive myth either.

I spend prob half my time validating what I have been taught. I have even had a ED physician (also a Medical Command physician) along with an RN give me :censored::censored::censored::censored: because I requested orders for captopril (which we carry) in a obvious CHF patient. I asked the doc why I was denied and all he could say was, "generally patients are only on ACE inhibitors for long term use and we don't give them emergently"... I was quite taken back by this response. We carry captopril and evidence suggest much better outcome with early ACE inhibitor use. And not to mention many EMS systems and hospital ED's give early ACE inhibitors for CHF. They also claimed that no other medic had ever requested orders for captopril.

You need to take the lead and find out for yourself. Don't play follow the leader and believe everything your textbook says. It's unfortunate the textbook still teaches what it does about oxygen.

First off, allow me to clarify. I completely agree with telling someone to "look it up" as this builds retention. I am not a proponent of spoon-feeding anyone anything. I, for one, did not state that anyone was wrong, or that the textbooks were right. I completely agree that they are built for the lowest common denominator and inadequate at best. I was upset that people were telling these basics to leave behind what they were taught and do "X" instead. What frightens me is that will most likely say "okay! I learned something!!!" when in reality they have no idea what they are talking about and will now go about withholding O2 because they think they know something about anything. The way you handled it in this post is perfect: "start here." THAT is how a basic, or anyone for that matter can learn. Have you tried navigating these forums? It can be a pain, and while I condone hard work, I do not believe that gaining access to education should be a rite of passage.

Oh, and really the only reason EMT textbooks are saying 100% for everyone is because the curriculum does not adequately teach Basics how to assess a patients oxygenation status. So it's a empirical blanket treatment with no evidence to support it.

Agreed 100% on the whole of texts available.

Did it ever occur to you that in telling you to look up the answer, you might learn and retain the information more readily than having it spoon-fed to you?

I'm well versed on the hows and whys. I got that way through my own research. Perhaps you should try the same.

Yes. That has occured to me. When I was 6 and my father taught me that lesson. He also handed me a dictionary and a paramedic textbook (read: tools to find the information). I was not saying to spoon feed, I WAS saying that "Google It" is a lame a** response. I have gotten to where I am on my own as well and if I do not know the answer then I know a way to find it. I am unwilling to stake the lives of patient's abroad on the fact that unless a care provider is as versed as I am on the how's and why's then screw em', let em find out on their own. When I could at least point them in the right direction (read: search this forum for oxygen and MI, CVA, etc.)

 

[mintygood]

For everyone here who thinks that every patient should get 15l/m NRB needs to check out some of Dr. Bryan Bledsoe's publications. He extensively cites how O2 can be harmful in an EMS context.


Edit: Lets grow up and recognize that EMT-B class is retardedly easy and is geared for people fresh out of highschool. What is easier: 1) O2 everyone because it doesn't hurt MOST patients or 2) explain in great detail which patients are harmed by high concentration O2, teach EMT-B's to recognize these pts, and explain why it can be harmful.

1 is easier and MOST pts are kept out of harms way when the majority of 911 trucks are ALS.

People, just because the textbook says it doesn't mean it's the indisputable truth. Open your mind, do some research, and, for god's sake, take some pride in providing quality pt care.

 

[usalsfyre]

Yes. That has occured to me. When I was 6 and my father taught me that lesson. He also handed me a dictionary and a paramedic textbook (read: tools to find the information). I was not saying to spoon feed, I WAS saying that "Google It" is a lame a** response. I have gotten to where I am on my own as well and if I do not know the answer then I know a way to find it. I am unwilling to stake the lives of patient's abroad on the fact that unless a care provider is as versed as I am on the how's and why's then screw em', let em find out on their own. When I could at least point them in the right direction (read: search this forum for oxygen and MI, CVA, etc.)

Ok, I do want to appolgize, I came off more ****ish in my post than I intended. Your absolotely about pointing people in the right direction. What got my ire up in your post was the implication that most on here either didn't know what they were talking about or were lazy. Which is not the case from what I've seen. Arrogant? Sure. Convinced that we are ABSOLOUTLELY right? At times. Lazy and stupid? Not at all. Newbies have been pointed in the right direction over and over again. Some have listened. Others refuse to and leave. Forgive me personally if I get a little fatigued of arguments like this at times. Like I said, went more nuclear than need be and feel bad about that now.

 

[usalsfyre]

For everyone here who thinks that every patient should get 15l/m NRB needs to check out some of Dr. Bryan Bledsoe's publications. He extensively cites how O2 can be harmful in an EMS context.

Dr Bledsoe is a heretic who blasphemes against the true faith in EMS.....

(which is to say, he's probably a pretty good guy to listen to...)

 

[mintygood]

Dr Bledsoe is a heretic who blasphemes against the true faith in EMS.....

(which is to say, he's probably a pretty good guy to listen to...)

He is one of the few that calls out all of the BS and superstition in EMS. So say we all.

 

[flyfisher151]

So...my EMT training is BS...?.My textbooks are all lies? Dont give anybody O2? Dont use the BVM? Dont use EPI? All I'm being taught is worthless? The inspiration is infinite here. See ya in the trenches.
Great thought provoking discussion! Guess I will be signing up for some more classes after my worthless basic class. I understand that this is a life long, ever changing environment, but where are we supposed to start? EMT-B seemed like a good place. I do plan on continuing my education. I have noticed a lot of animosity amongst the different ranks here. It is helping me start to get a grasp on some basic concepts. Keep battling it out! It helps me look at other angles I might not have thought of before I actually get a patient before me I have to help make it to the ER.
THANKS for all the comments positive and negative.

PS I do realize that most "basic" courses are exactly that. And, I also realize that the actual learnig takes place in the field and from some mentors whether it be another Basic with 20 years experience, a competent Medic, RN, RT, MD etc. Looking forward to learning a tid bit from all of you as well!

 

[18G]

EMT training isn't all BS but it is limited and not as capable as some make it out to be.

Yes, I am a Paramedic now but have spent more time as an EMT working for a FD EMS service then a Medic. A large part of my motivation to become a Paramedic was due to my getting tired of the same old thing call after call. Talk to the patient, take vitals, place em on the stretcher, maybe O2, and transport. In the beginning I was sold on the EMT's save lives propaganda and was a hardcore believer. As the years went on I took notice that most of the calls we responded to BLS could have been handled POV with no difference in outcome.

Asking a patient 5000 questions does nothing to address their ailment. Taking vitals does nothing to directly treat a condition. O2 of which we thought was more good than bad is now not so true so as BLS we are doing less of that. Basically, I felt like a taxi ride. And yes, a good assessment is very important but at the BLS level after you do your assessment you have to stop the majority of the times because you don't have the capability to go to the next step which is treatment. Least as a Paramedic we assess and then have some good treatment options to directly make the patient better.

Don't get me wrong EMT training is important and can make a difference in priority conditions but those are the exception.

 

[flyfisher151]

Great sig line! That pretty much nails it. I will most likely move on education wise ASAP. I see the limitations and doldrums associated with the B status. Gotta start somewhere!

 

[18G]

Great sig line! That pretty much nails it. I will most likely move on education wise ASAP. I see the limitations and doldrums associated with the B status. Gotta start somewhere!

You have a great attitude. And please don't get me wrong, what your learning in Basic is useful and is a good stepping stone. Just don't let it inflate your ego and always strive for higher.

 

[Handsome Rob]

Ok, I do want to appolgize, I came off more ****ish in my post than I intended. Your absolotely about pointing people in the right direction. What got my ire up in your post was the implication that most on here either didn't know what they were talking about or were lazy. Which is not the case from what I've seen. Arrogant? Sure. Convinced that we are ABSOLOUTLELY right? At times. Lazy and stupid? Not at all. Newbies have been pointed in the right direction over and over again. Some have listened. Others refuse to and leave. Forgive me personally if I get a little fatigued of arguments like this at times. Like I said, went more nuclear than need be and feel bad about that now.

It's all good. What's the forum for if not to get a little sharp knowing that the person, hopefully, can take the heat and respond intelligently. I COMPLETELY understand the frustration with saying the same thing over and over and over and over and..ya get it.

For everyone here who thinks that every patient should get 15l/m NRB needs to check out some of Dr. Bryan Bledsoe's publications. He extensively cites how O2 can be harmful in an EMS context.


Edit: Lets grow up and recognize that EMT-B class is retardedly easy and is geared for people fresh out of highschool. What is easier: 1) O2 everyone because it doesn't hurt MOST patients or 2) explain in great detail which patients are harmed by high concentration O2, teach EMT-B's to recognize these pts, and explain why it can be harmful.

1 is easier and MOST pts are kept out of harms way when the majority of 911 trucks are ALS.

People, just because the textbook says it doesn't mean it's the indisputable truth. Open your mind, do some research, and, for god's sake, take some pride in providing quality pt care.

Agreed 100%!

Least as a Paramedic we assess and then have some good treatment options to directly make the patient better.

...unless you practice in LA County...lol

 

[CAOX3]

I wouldn't call it a panic attack or an allergic reaction. Sometimes chemical stimuli can trigger a reactive airway, and then the anxiety of that feeling can spin the drama right out of control.

I believe I could sit here and breathe 44 times a minute, shallowly as if my airway feels tight and burns, and could approximate those vitals.

I'm not saying you were faking it, or there wasn't an actual problem, just that all of those vital signs can be explained by the hyperventilation, and they don't look like an allergic reaction at all. It is extremely uncomfortable, and anxiety-provoking to have a reactive airway thing going on, and I would say that the problem was related to something along those lines.

Bingo I had this happen while cleaning a stretcher in the ambulance entrance with the doors closed, I know not to bright, but it was late amd all I could think about was getting to bed. Couldn't catch my breath, amd them the welts stated on my chest and neck. They attributed it to some type of chemical reaction. So now I do all my cleaning outside and have never had another issue and I use the same cleaning supplies.

 

[NREMTB12]

No cardiovascular, respiratory or integumentary symptoms and an increasing blood pressure leads Brown to say this is not anaphylaxis.

Could have been a panic attack but Brown does not see any sort of stimuli

Most likely cause is the bleach

... and why in the bloody hell where there FOUR IC's at this job?

Seems like you said a chemical reaction almost similar to smoke being inhaled by someone with asthma or other respiratory pathology, just triggers a firestorm.