Any comments on this one......

[emt seeking first job]

Your best guess. Was this senility or was this man always un-informed.

An 88 year old retired MD, an orthopedist. Must have been successful, nice house, clean, well maintained.

He complained of weakness, fainted twice, his wife reported his blood pressure was fluctuating all day, hi, then lo.

We responded and he was found in bed in a supine position. BP 140/88, pulse 42, we called for medics. The unwritten rule with the medics is when they arrive there had better be 02 already hooked up.

So the patient was questioning why we were giving him 02 as he was not having any difficulty breathing......

He complied when three EMTs, his wife, daughter and grandaughter all agreed he should have it (mass suggestion).

So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?

 

[CAOX3]

My treatment is based on assessment, I don't care what the medics want or unwritten rules, if oxygen isnt warranted they don't get it.

What did his lungs sound like, was he in any distress, what are you basing the oxygen administration on?

 

[usalsfyre]

Perhaps because in the absence of hypoxia, oxygen isn't appropriate?

 

[Afflixion]

You did not obtain O2 sat levels? I would have to say provided he was saturating fine he would not need O2. Despite what is preached O2 is not some magical cure all drug, and in some cases can be quite detrimental to the patient, granted that was not the case here but there does not appear to be any reason for O2 other than something else to charge the insurance company that is.

 

[emt seeking first job]

You did not obtain O2 sat levels? I would have to say provided he was saturating fine he would not need O2. Despite what is preached O2 is not some magical cure all drug, and in some cases can be quite detrimental to the patient, granted that was not the case here but there does not appear to be any reason for O2 other than something else to charge the insurance company that is.

In NYS EMT-b do not obtain 02 sat levels.

In the EMT-b class the mantra was give 02.

The service I work in is 100% free. We do not even bill insurance.

02 is considered theraputic, makes people more alert and aids in depression.

 

[emt seeking first job]

My treatment is based on assessment, I don't care what the medics want or unwritten rules, if oxygen isnt warranted they don't get it.

What did his lungs sound like, was he in any distress, what are you basing the oxygen administration on?

Clear bilateral.

The two people I was with were senior to me and I was told to do it.

I will add that the medic who showed up told me to ride in his bus. He knows me and he knows I do what I am told. I also remain quiet. I pick up anything the medics discard to the floor. He also knows without being told I, after the patient in transfered to the hospital bed, always wheel out the stretcher, wipe it down with anti-bacterial cloth, throw a clean sheet on it, and strap the life-pack, with an extra sheet tucked under it.

I ALWAYS get picked to ride with the medics.

I am over 40, I have no prior health care experience. I just got my emt card and have less than 50 patient contacts. My only virtue is that I shut up, do what I am told and my mobile phone stays in my pocket in front of other people.

 

[CAOX3]

Great it seems like your a team player and that's important, your also a patient advocate. Oxygen isnt a benign treatment its a medication like any other and should be administered as such. Trust me I'm not attacking you personally, it s a nationwide problem, they have shortned classed removed anatomy and physiology and moved towards a system where you just throw everyone on oxygen and call for a medic truck.

I commend you for keeping the medics coming the guys heart rate needs to be addressed but remember also this isnt apopularity contest either, you need to do what's in the best interest ofyour patient a medic its going to respect you more for doing a complete assessment and treating appropriately then one who follows blanket policies and unwritten rules.

There are some great threads here about the administration of oxygen and google is also a great resourceif your not able to take any traditional classes right now.

trust me you will get more satisfaction and respect out of being a competent provider then you will from being the guy the medics want to ride because you will clean up their mess.

 

[Shishkabob]

He complied when three EMTs, his wife, daughter and grandaughter all agreed he should have it (mass suggestion).

So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?

Since when do 3 presumably non-medical people, and 3 minimally trained medical people know what is and is not appropriate insofar as providing medical care, especially when given the info provided, is inappropriate, and the doctor states as such?

I don't care what the "unwritten rule" is, I'm doing what's appropriate.



If he was AOx4 and capable of making his own decisions, no reason to pressure him on such a minuscule procedure that most likely was not indicated... especially at 15lpm

 

[John E]

Hmmm...

sounds like the alleged senile MD knows more about how to treat a patient with his symptoms than the entire group of EMT's and family members combined.

Did the O2 help alleviate any of the symptoms, did it make the patient more comfortable, was it continued after his presumed arrival at the ER?

Why is it your job to clean up after the Paramedics?

Your candor about your own virtues is refreshing but you don't need to be a doormat to anyone.

 

[usafmedic45]

Was this senility or was this man always un-informed.

I don't think he was the one who was misinformed nor senile.

02 is considered theraputic, makes people more alert and aids in depression.

Care to provide some proof for that? Better yet, just go kick whomever told you that crap in the groin hard enough that they can't spawn another generation of morons.

 

[JPINFV]

Was this senility or was this man always un-informed.

So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?

Why is O2 indicated? In medicine there's very few instances of automatically administering oxygen to a eupneic patient, and even those are starting to be revised.

 

[reaper]

While you may think it is cool to be picked by the medics to ride along, they are picking you, because you do their clean up. Not because they respect you as a provider. It is nice to help out, but why were you not in the ED learning what was wrong with the pt? instead of cleaning their truck.

As stated, assess your pt and treat appropriately. Not do something because the medics expect it. This pt has more medical knowledge then the entire cast of people sent to treat him. Why not listen to the man?

 

[usafmedic45]

While you may think it is cool to be picked by the medics to ride along, they are picking you, because you do their clean up. Not because they respect you as a provider. It is nice to help out, but why were you not in the ED learning what was wrong with the pt? instead of cleaning their truck.

As stated, assess your pt and treat appropriately. Not do something because the medics expect it. This pt has more medical knowledge then the entire cast of people sent to treat him. Why not listen to the man?

BTW, was this in Kentucky by any chance?

 

[fast65]

Like everyone else has said so far, oxygen was in no way indicated for this patient. He was obviously AOx4 without any breathing difficulties or anything that would even make you think he needed oxygen. Despite what they tell you in basic class, oxygen isn't needed on every patient; don't get me wrong, I'm not trying to bash you, but I'm just saying that it's more important to thoroughly assess a patients need for oxygen before tossing a NRB on them.

 

[emt seeking first job]

trust me you will get more satisfaction and respect out of being a competent provider then you will from being the guy the medics want to ride because you will clean up their mess.

Remember, I work at a volunteer service in an area already served by paid EMTb responders. Nobody forces me to do it. On that one job the patient's family called us but on many we buff them off the radio.

Its like if I crash a party (which I have never done, just an expression) I would be sure to show up with a bottle of wine in each hand.

And on one call, which we buffed, the same paramedic told his own agencies EMTs that they could leave since we were there.

The way I see it, I am not cleaning up their bus for them, I am making it clean for the next patient and enabiling them to return to service quicker.

And more than once those medics have offered me food and beverage when they are running to the deli. Remember, I am not being paid and I have cut back hours at my paying job (non-emt) to spend time EMT-ing and have cut back my take out food purchases (among other exspenses).

 

[emt seeking first job]

Thank you for the replies.

So the answer is o2 is not always medically indicated even while it is not harmful. An MD would only administer o2 in more limited circumstances. The EMT class mantra of always put them on o2 is not always agreed upon.

I think it should be noted here that this in in NYC where the ride to the Hospital is ALWAYS under 15 minutes and on average around 5.

And thank you for the advice about respect etc, but I am nobody's 'biotch', I am just being a good guest. The unwritten rule at my service is the newer person cleans up. People with a higher # with me, I always ensure they do it.

The biggest complaint the medics have about other EMTs in my service is they brag, don't shut up, or assume they have a closer aquaintance-ship they than they do.

 

[EMSrush]

I don't think he was the one who was misinformed nor senile.
Care to provide some proof for that? Better yet, just go kick whomever told you that crap in the groin hard enough that they can't spawn another generation of morons.

My sentiments exactly.

 

[emt seeking first job]

assess a patients need for oxygen before tossing a NRB on them.

In certain instances we do our assesment with the o2 on and as I said, as a service we are trying to either load an go and play on the way rather than stay and play. The hospital is a five minute ride and the patient really needs to be assesed by the ER staff more than us.

The patient in this thread, our crew chief did not want to move him because of the bradycardia.

 

[JPINFV]

So the answer is o2 is not always medically indicated even while it is not harmful.

Part of the problem is that supplemental oxygen is not not harmful. It might not be immediately harmful, but it's not benign either.

 

[emt seeking first job]

http://nursingcrib.com/nursing-notes-reviewer/oxygen-therapy/

It's really OK, I am very thick skinned. Flame away.

I enjoy reading any response on this forum, even the opinions, right, worng or indifferent it is all good.

I respect every one's opinon here, however, when someone in my service senior to me directs me to put the patient on o2, or any lawful request that does not violate REMSCO protocols, I am gonna follow it without question.

Especially if it makes the patient alert and less depressed.

So flame away, and link up some good meme's.......

:wacko::wacko::wacko::wacko:

:unsure:B):unsure:B):unsure:B):unsure:B):unsure:B):unsure:B)