Assisting breathing...

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gsxr150

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We know normal adult breathing is 12-20...I am reading that an EMT should be concerned below 8, and above 24. If breathing was normal but a rate of 9, would you NOT give assisted breaths?

Sorry, I know what I would do in real life, but not so sure about the reg.

Thanks guy/gals.
 
gsxr150 said:
We know normal adult breathing is 12-20...I am reading that an EMT should be concerned below 8, and above 24. If breathing was normal but a rate of 9, would you NOT give assisted breaths?

Sorry, I know what I would do in real life, but not so sure about the reg.

Thanks guy/gals.
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Stop getting fixed on numbers. Look at your patient. Do they look like they need to be bagged?
 
KNOW the difference BETWEEN VENTILATION & OXYGENATION!
Just a hint, the number 1 NREMT fail area.

R/r 911
 
I imagine if you start bagging someone breathing 9 breaths a minute but with adequate perfusion, they might just try to punch you.

It's not normal to only have 9 per minute, but it MAY not be worthy of busting out the BVM. Like Sasha said, treat your patient not the numbers.

The biggest folly I see from people in this department is the PulseOx. They see 95% and start to panic some times, even if the patient is sitting there perfectly normal and adequate. Hell, I don't think I've EVER satted above 97% when testing it out before every shift and I'm perfectly healthy.
 
Ridryder911 said:
KNOW the difference BETWEEN VENTILATION & OXYGENATION!
Just a hint, the number 1 NREMT fail area.

R/r 911
Click to expand...

I know what you mean about the difference, because you can ventilate a CO toxicity pt and they may be ventilating themselves within a normal rate but not have any oxygenation (perfusion). But what is the difference between the two pertaining to NREMT? As a basic, I won't get that I'm sure, but what can I do since the CO stops the O2 binding to the red blood cells. Just give them O2, and try to "flush out" the CO with an NRB (If they have adequte volume, full breaths, etc, else I'd BVM)? And if for some reason this happened, I would obviously call ALS, but what could I do?

Thanks
 
Just give them O2, and try to "flush out" the CO with an NRB (If they have adequte volume, full breaths, etc, else I'd BVM)?
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You're not going to be able to "flush it out". Once a CO binds, the receptor site "closes" so to speak. CO poisoning? Get them away from the source of the carbon monoxide.
 
Sasha said:
You're not going to be able to "flush it out". Once a CO binds, the receptor site "closes" so to speak. CO poisoning? Get them away from the source of the carbon monoxide.
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That's what I thought about that, but I was mostly using it as an example between the differences of Ventilation and Oxygenation, since you can ventilate a CO poisining, and not get any oxygenation at the same time. But my biggest question was what were the differences between the two in regards to the NREMT.

Thanks for responding.
 
exodus said:
That's what I thought about that, but I was mostly using it as an example between the differences of Ventilation and Oxygenation, since you can ventilate a CO poisining, and not get any oxygenation at the same time. But my biggest question was what were the differences between the two in regards to the NREMT.

Thanks for responding.
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I'm sure someone else will answer this more indepth for you, but the way I knew it at a basic level is ventilation is the mechanical act of breathing. Oxygenation refers to the actual gas exchange taking place. If there is no gas exchange, bag them all you want, 12 times, 20 times, 30 times a minute, good chest rise and all, but they're still gonna die.
 
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Sasha said:
I'm sure someone else will answer this more indepth for you, but the way I knew it at a basic level is ventilation is the mechanical act of breathing. Oxygenation refers to the actual gas exchange taking place. If there is no gas exchange, bag them all you want, 12 times, 20 times, 30 times a minute, but they're still gonna die.
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Yeah, which is the reason we monitor their pulse rate while we are ventilating, and if they're pulse begins to return to normal, we are getting good perfusion (gas exchange, correct?)

exo
 
Regarding the NREMT

I don't think CO poisoning is a good example of ventilation vs. oxygenation for the NREMT.

As Sasha said the only EMS treatment would be to remove them from the source. The only definitive treatment is oxygen therapy, which we can start but we definitely aren't going to finish, and its my understanding (please correct me if I am wrong) that technically the blood is oxygenated, its the tissues that are unable to utilize the oxygen because its unable to leave the blood. Treatment isn't bagging oxygen (unless they are unconscious) rather 100% O2 to displace the carbon monoxide.

The way I looked at Oxygenation vs Ventilation for the test was to think simple. Is the patient getting good tidal volume to allow for CO2 and O2 exchange (Oxygenation). If the patient is taking solid breaths at 9 Resp/min you wouldn't bag, because 9 breaths with good tidal volume is probably allowing adequate oxygenation. If they were not drawing good tidal volume, you might reinforce their 9 resp/min to get the desired oxygenation. Its not just about their RR, its more about adequate gas exchange. 9 good breaths a minute > 20 extremely shallow breaths.
 
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SanDiegoEmt7 said:
I don't think CO poisoning is a good example of ventilation vs. oxygenation for the NREMT.

As Sasha said the only EMS treatment would be to remove them from the source. The only definitive treatment is oxygen therapy, which we can start but we definitely aren't going to finish, and its my understanding (please correct me if I am wrong) that technically the blood is oxygenated, its the tissues that are unable to utilize the oxygen because its unable to leave the blood. Treatment isn't bagging oxygen (unless they are unconscious) rather 100% O2 to displace the carbon monoxide.
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The oxygen is still there, but it doesn't want to leave the hemoglobin its bound to. There's four sites on hemoglobin that oxygen will bind to. If CO is occupying one site, the remaining three sites have a higher oxygen affinity. This makes the oxygen stay bound to the hemoglobin rather than absorbing into the tissues.


And yeah... really the only treatment is to be removed from the source and placed on oxygen. If it's severe enough, a hyperbaric might be used, assuming the facility has one.


I've twice spent hours in an ER on a nasal cannula waiting for my blood draws to come back with a safe CO level.
 
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