ALS Protocol Question

[sdadam]

So, in SD county the protocol for altered neuro function in a suspected CVA pt is to only give them O2 if the Sat is <92%. it's not in the BLS protocol, only ALS.

so my questions are these:

does anyone elses county share a similar protocal for a poss. cva.

and does anyone know the physiological theory behind withholding O2 in stroke pts.?

thanks guys.

adam

 

[akflightmedic]

I will give the short simple answer, Rid can come do all the technical.

Basically in the field, you can not determine which type of stroke the patient experienced. So, since there is a risk of the patient having a hemmorhagic stroke(which means blood is leaking in to the brain out of a ruptured vessel) you do NOT want to do anything that may speed up cerebral perfusion.

The blood leaking into the brain causes a whole host of problems, basically causing all kinds of degradation and free radicals, etc to float around in areas they should not be.

If you give high flow oxygen, you may increase cerebral perfusion which will in turn speed up the dumping of blood into the brain, which is bad juju.

Therefore, to prevent this, we give minimal O2 if any at all unless they are showing signs of hypoxia.

In critical care settings, it is the norm to actually allow CVA pts on a vent to be in a hyperventilated state. This action decreases cerebral perfusion and may reduce the amount of damage caused.

Hope this helps!!

 

[Ridryder911]

Ditto to AK statements...

As well your cerebral arteries have a special "receptor" that responds to oxygen levels. This is good and bad. The good point is will cause vasoconstriction of those cerebral arteries and decrease blood supply (which one would think be good) but decreasing blood supply will cause lack of blood supply to the tissue and thus increasing infarct (death of cells).

That is one of the other reasons hyperventillation and over oxygenation is now contraindicated.

R/r 911

 

[firemedic1563]

Thank you for clearing that up. I had heard that, but have not gotten aclear explanation as to why. Unfortunately, our state protocols are largely unchanges, and every gets O2. Although, if put in the situation with a patient, one may opt to go against protocol as long as the doc agrees.