BVM mishap. Did I do something wrong?

Remi: the way I see it it is better to take the risk with an OD patient because sometimes it can appear that they are addiquatly profusing when they are not.. You can't measure how much air they are moving and someone with an AMS is at risk for an airway obstruction with their tongue.

DEmedic: it certainly does! Do you not know how an NPA works? It goes through the nasal passage and if measured correctly will go to the end of the pharynx, just behind the tongue which would cover the epiglottis..
 
RobertAlfanoNJEMT said:
Remi: the way I see it it is better to take the risk with an OD patient because sometimes it can appear that they are addiquatly profusing when they are not.. You can't measure how much air they are moving and someone with an AMS is at risk for an airway obstruction with their tongue.
Click to expand...
Perfusion (I think that it what you meant) is an entirely different thing from ventilation.

You can adequately measure the amount of air movement simply by placing your hand in front of their nose and mouth. If you can feel air movement.....they are not obstructing. At least not to a point that needs to be addressed immediately. If they are obstructing, often turning their head to one side will alleviate it.

OPA's are a great tool to use when indicated. But if air exchange is good, they are not indicated and placing one would therefore be a practice error.
 
Oh that's genius! Why didn't I think of that! I could just turn the physically agitated patients head to the side! Because they'll leave it like that right? You do what you've got to do and I'll use my own discretion to keep people livin
 
RobertAlfanoNJEMT said:
Remi: the way I see it it is better to take the risk with an OD patient because sometimes it can appear that they are addiquatly profusing when they are not.. You can't measure how much air they are moving and someone with an AMS is at risk for an airway obstruction with their tongue..
Click to expand...

You can adequately measure the effectiveness of their ventilations; it's called ETCO2.


Sent from my iPhone using Tapatalk
 
Last edited:
RobertAlfanoNJEMT said:
Oh that's genius! Why didn't I think of that! I could just turn the physically agitated patients head to the side! Because they'll leave it like that right? You do what you've got to do and I'll use my own discretion to keep people livin
Click to expand...
So you can't turn a physically agitated patients head to the side because they may move it back but yet an OPA or NPA they will tolerate with no problems?
 
RobertAlfanoNJEMT said:
Oh that's genius! Why didn't I think of that! I could just turn the physically agitated patients head to the side! Because they'll leave it like that right? You do what you've got to do and I'll use my own discretion to keep people livin
Click to expand...
Oh so now they are agitated. But they still need an OPA?

You are either a great troll or have absolutely no idea what you are talking about.
 
DesertMedic66 said:
So you can't turn a physically agitated patients head to the side because they may move it back but yet an OPA or NPA they will tolerate with no problems?
Click to expand...
Yes they will because their agitation and discomfort supersede that of the NPA.. I'm not talking out the *** this is something I have seen more than once in the heroin rich area I live in
 
Remi said:
Oh so now they are agitated. But they still need an OPA?

You are either a great troll or have absolutely no idea what you are talking about.
Click to expand...
The need an NPA not an OPA.. Which is what I've been saying! Have you really never seen an overdose parient who squirms around moaning with an AMS that isn't cognitively alert enough to maintain their airway?? I know what I'm talking about I see a lot of ODs in my area!
 
RobertAlfanoNJEMT said:
The need an NPA not an OPA.. Which is what I've been saying! Have you really never seen an overdose parient who squirms around moaning with an AMS that isn't cognitively alert enough to maintain their airway?? I know what I'm talking about I see a lot of ODs in my area!
Click to expand...

I've managed a few airways, too. To each his own.
 
RobertAlfanoNJEMT said:
We don't carry ETCO2.. I don't think anyone does!
Click to expand...

We carry it both in line and via nasal prongs. Goes on all my altered LOC pt's, most of my respiratory patients and certainly any whose airways and ventilations I'll be managing.

There's an excellent review package (and some others) from our medical direction at this link:
https://www.lakeridgehealth.on.ca/en/ourservices/pastcmeandselfstudy.asp

Being presented with ideas that challenge your practice is not a personal affront, it's important to know the limits of your current knowledge and always be striving to push those limits a bit further.
 
RobertAlfanoNJEMT said:
We don't carry ETCO2.. I don't think anyone does!
Click to expand...
An ALS ambulance would. You know, the kind of resource that should be taking care of these patients in this area apparently...
RobertAlfanoNJEMT said:
The need an NPA not an OPA.. Which is what I've been saying! Have you really never seen an overdose parient who squirms around moaning with an AMS that isn't cognitively alert enough to maintain their airway?? I know what I'm talking about I see a lot of ODs in my area!
Click to expand...
No, no I have not. A squirming and moaning patient is likely to not need supplemental ventilation but I'll just bow to your vast experience now. Also basic adjuncts do not maintain an airway. But yea.
 
Tigger said:
An ALS ambulance would. You know, the kind of resource that should be taking care of these patients in this area apparently...

No, no I have not. A squirming and moaning patient is likely to not need supplemental ventilation but I'll just bow to your vast experience now. Also basic adjuncts do not maintain an airway. But yea.
Click to expand...
Who gets on scene first ALS or BLS? I don't understand why all of you medics can't stick to the ALS forum because you seem to have forgotten your days as a basic when there aren't a lot of skills you can utilize to care for your patients. When I get on scene and am the highest level of medical attention I get to make that call as I see fit. If ALS wants to undo what I have done or modify it so be it, but until they get there it is my call and their lives are my responsibility! To the other point I have had a number of patients who were squirming babbling and having snoring respirations, stick the NPA in and they start sucking air through it like there's no tomorrow!
 
RobertAlfanoNJEMT said:
Who gets on scene first ALS or BLS? I don't understand why all of you medics can't stick to the ALS forum because you seem to have forgotten your days as a basic when there aren't a lot of skills you can utilize to care for your patients. When I get on scene and am the highest level of medical attention I get to make that call as I see fit. If ALS wants to undo what I have done or modify it so be it, but until they get there it is my call and their lives are my responsibility! To the other point I have had a number of patients who were squirming babbling and having snoring respirations, stick the NPA in and they start sucking air through it like there's no tomorrow!
Click to expand...
1. ALS Fire often gets there first... Unless the ALS ambulance does.
2. ALOC is not a BLS call.
3. No one is saying that an NPA is a bad move... Saying to ALWAYS do (insert thing here) is a bad practice even if it's just an NPA (and they do kinda hurt). If an intervention is indicated; do it.
4. I remember being an EMT... I have since realized I didn't know ****.


Sent from my iPhone using Tapatalk
 
Last edited:
RobertAlfanoNJEMT said:
Who gets on scene first ALS or BLS? I don't understand why all of you medics can't stick to the ALS forum because you seem to have forgotten your days as a basic when there aren't a lot of skills you can utilize to care for your patients. When I get on scene and am the highest level of medical attention I get to make that call as I see fit. If ALS wants to undo what I have done or modify it so be it, but until they get there it is my call and their lives are my responsibility! To the other point I have had a number of patients who were squirming babbling and having snoring respirations, stick the NPA in and they start sucking air through it like there's no tomorrow!
Click to expand...
You don't know what you don't know.

Putting an NPA in is fine, though it might help to have a good idea of why it works and what the potential complications are. But you don't get to run the call as you see fit. You get to run the call as medicine sees fit, you just implement (a tiny but important) part of that.
 
RobertAlfanoNJEMT said:
Who gets on scene first ALS or BLS? I don't understand why all of you medics can't stick to the ALS forum because you seem to have forgotten your days as a basic when there aren't a lot of skills you can utilize to care for your patients. When I get on scene and am the highest level of medical attention I get to make that call as I see fit. If ALS wants to undo what I have done or modify it so be it, but until they get there it is my call and their lives are my responsibility! To the other point I have had a number of patients who were squirming babbling and having snoring respirations, stick the NPA in and they start sucking air through it like there's no tomorrow!
Click to expand...

A little bit of knowledge is a dangerous thing.

Anecdotal evidence, that is what you learn from direct experience, is dangerous because it has a greater impact then knowledge gained from data. This is a common pitfall for providers who begin to make decisions based on past experience (good/bad) and pattern matching. Take a step back let your hackles down and realize there is good I for here from knowledgable clinicians that you can learn from. You seem to be taking disagreement very personally.

As far as ALS providers staying out of BLS forum, well in my system I am a BLS provider so I think I'll stick around.

Let's take a few steps back and consider the OD patient requiring ventilatory and airway management.

First toxidromes. What drug has been taken and how is it effecting their respirations? Opiates and benzos are going to suppress respiratory drive as well as being sedative. Assume this patient is presenting w/ bradypnea, decreased O2 sats, hypercapnea and decreased LOC.

You begin to assist ventilations and insert an airway adjunct. As you're bagging them they begin to moan and move about as you've described. Consider at this point that the patient's condition despite not being reversed via narcan may have improved due to improved oxygenation and ventilation. So yes, your OD patient is demonstrating the behaviour you described, but I would argue that at this point reassessment is indicated which may find that their inherent respiratory rate and depth as well as improved LOC may make continued used of an airway adjunct unnecessary.
 
You must log in or register to reply here.
Back
Top