BVM on breathing pt

[skyemt]

True, but I would argue that the damages resulting from failure to recognize respiratory failure, especially for EMT-Bs and FRs, far outweigh the negative consequences of not knowing the semantics of FiO2, tidal volume, PEEP, ETCO2, etc.

semantics of FiO2??

i can assure you... as someone who has been studying this very topic for two days... you would change your opinion greatly if you were more knowledgable about the physiology of ventilation and respiration...

not a criticism, but a promise...

 

[Explorer127]

wow, im kinda surprised that people are still responding to this question, lol. i gotta say, that last post was pretty funny, lol.

btw, the person who was asking before about whether where I am a First responder can use a bvm, the answer is yes. and i'm not from WA, but from connecticut. basically here, an MRT (some places call it a first responder) can do anything an EMT can do. however, you do need to be with a basic, at all times.(unless of course, you're on scene alone

 

[ffemt8978]

All right, people. I've already had to remove a couple of posts here for a violation of our forum rules. Please take a moment and review these rules and remember that we take the BE POLITE rule seriously.

You may disagree with what is posted, and may present valid arguments to support your beliefs but you may NOT post anything that is rude, inflammatory, derogatory, or insulting to any other forum member.

 

[Doughboy]

btw, the person who was asking before about whether where I am a First responder can use a bvm, the answer is yes. and i'm not from WA, but from connecticut. basically here, an MRT (some places call it a first responder) can do anything an EMT can do. however, you do need to be with a basic, at all times.(unless of course, you're on scene alone

Omar, I wasn't asking if you could or could not use a BVM, but whether or not you could use it on a conscious patient. Making a blanket statement about your scope of practice, i.e. that you can do anything an EMT can do, is pretty hazardous. Have you been trained to do everything an EMT has been trained to do? I'm really asking because I'm unfamiliar with your state's protocols, and the CONN OEMS' web page is borderline incomprehensible, but have you been trained to administer medication, for example? If not, and an EMT let you do this, they'd be putting their license at risk by letting you do it. I'm not trying to rag on your certification level at all, I just don't know.


Sky, I'll try to address this in a way that doesn't get my post deleted:

Please don't presume to know anything about my education.

It is extensive.

Just because I don't believe EMT-Bs and FRs need to know the what FiO2 means in order do their jobs does not mean that a) I don't know what it means, or, more importantly b) that they don't need to understand the concepts underlying respiration and ventilation.

In the future, please consider basing your argument on what you know, not what you think other people don't know.

 

[certguy]

Doughboy ,

Since when is assisting a conscious pt's respirations such a hard skill ? You match thier breaths and as Bossy said , this also lowers thier anxiety . As an asthma pt. myself , believe me , I can relate to that . If you haven't experienced it yourself it's like 2 bodybuilders wrapping a chain around your chest and pulling at both ends while you're trying to breathe through a stir straw . It's scary , and it sucks . The goal of an FR is to provide care till EMS can get there . The sooner you provide better oxygenation and ease the anxiety , the better . These guys may not have as much training as the rest of EMS , but they can and do save lives . Give them a break , you may be one of thier pts. some day .

 

[VentMedic]

Just because I don't believe EMT-Bs and FRs need to know the what FiO2 means in order do their jobs does not mean that a) I don't know what it means, or, more importantly b) that they don't need to understand the concepts underlying respiration and ventilation.

In the future, please consider basing your argument on what you know, not what you think other people don't know.

So you don't believe an EMT should know if they are giving 100% or 21% oxygen? I really have to disagree with you there. Oxygen is considered a medication and there should be some understanding about the concentrations you are administering.

Assessing oxygenation by color and mentation as well as ventilation by rate, depth and quality should also be understood to know when and how much oxygen should be administered. That is where tidal volume or if you prefer "how much air with each breath" or "watch the chest go up and down" comes into the assessment. I do agree with MSDeltaflt about giving O2 in most cases but how much can be assessed physically and listening to the patient. They should also know when and why they refer to their protocols or use clinical judgement for some circumstances.

I believe FR and EMTs should be well trained to use the BVM when appropriate. This should include the equipment, hows and whys.

I also don't believe their education should stop with that one certificate. That should only be a foundation for continuing their education with more questions and seeking answers. Many of these professionals are very intelligent and deserve to be treated with respect as they advance their knowledge. Sometimes, though, it takes a little conversation that does go over their head alittle to spark more questions in their quest for knowledge. It would be too easy if "that is all there is".

 

[Doughboy]

Doughboy ,

Since when is assisting a conscious pt's respirations such a hard skill ?

Since... always? Not trying to be a smart-***, but I don't think it's easy to do. I've done it to tubed patients and trached patients, where there is more feedback from the pt's respirations than using a straight BVM, and I still think it's hard. Add in road noise and bumps, and it becomes even more difficult.


Vent:
.:sigh:.
I do think EMTs should know what ballpark % of O2 they are administering, as I have seen it taught in most EMT programs. What I said was that I'd hate to see time in EMT classes dedicated memorizing what FiO2, PaO2, ETCO2, etc. mean [semantics], when it could be dedicated to learning the actual concepts of care in a meaningful way that will affect patient care.

I agree with you 100% about ongoing education, but, realistically, is the average cop who receives FR training only because he or she is required to really going to go search pubmed for resuscitation statistics? This is why we need to be careful about the things we choose to teach at specific levels. Checking for pulses is no longer taught in AHA heartsaver CPR. I don't have to tell you why, because it sounds like you know your stuff, but clearly the trend is not towards complicating first responder training (which, in my mind, is not meant for medical professionals).

 

[VentMedic]

Vent:
.:sigh:.
I do think EMTs should know what ballpark % of O2 they are administering, as I have seen it taught in most EMT programs. What I said was that I'd hate to see time in EMT classes dedicated memorizing what FiO2, PaO2, ETCO2, etc. mean [semantics], when it could be dedicated to learning the actual concepts of care in a meaningful way that will affect patient care.

I am DEFINITELY not about memorizing formulas that will be forgotten. Did you even read why I mentioned the difference for the BVM at 40% and 100% before you started in with your criticism? The BVM is what the thread is about. I seriously don't think you would be interested in what information I could offer about the NC or NRBM. However, there are others that might want to know a little more about that also.

I also did not mention PaO2 or ETCO2 except when asked about it or in response to another member. PEEP, however, should be discussed if the BVM has a built in PEEP valve because some have a tendency to crank it down to 10 or 20 cmH20 even in a code situation to "get more oxygen".

The beauty of a forum is you don't have to read posts that don't interest you. It also allows you to ask questions that those in your immediate vicinity can not answer. There are also forums for cops and FFs if the medical conversation here is too intense for them. This forum has a variety of members from FR to Paramedic to RNs to RRTs and various combinations of all credentials. Most are seeking more medical information. The OP's questions have been answered and a link to another thread was added for more information at a basic level. The thread continued as it should if there are more questions. It shouldn't just stop with one or two posted answers.

This BVM question may be of interest to many levels, not just a FR. I teach med students, doctors both MDs and PhDs, as well as RNs the basics of the BVM all the time. This is not a unique question.

Dumbing done information is not always the best approach. Expecting very little from providers has left EMS in the dark ages when compared to other health care professions.

I really don't know why you are so hung up on "FiO2" being used. I can use oxygen in percentage since I see that is what you use in your posts if that makes you happier.

 

[skyemt]

Omar, I wasn't asking if you could or could not use a BVM, but whether or not you could use it on a conscious patient. Making a blanket statement about your scope of practice, i.e. that you can do anything an EMT can do, is pretty hazardous. Have you been trained to do everything an EMT has been trained to do? I'm really asking because I'm unfamiliar with your state's protocols, and the CONN OEMS' web page is borderline incomprehensible, but have you been trained to administer medication, for example? If not, and an EMT let you do this, they'd be putting their license at risk by letting you do it. I'm not trying to rag on your certification level at all, I just don't know.


Sky, I'll try to address this in a way that doesn't get my post deleted:

Please don't presume to know anything about my education.

It is extensive.

Just because I don't believe EMT-Bs and FRs need to know the what FiO2 means in order do their jobs does not mean that a) I don't know what it means, or, more importantly b) that they don't need to understand the concepts underlying respiration and ventilation.

In the future, please consider basing your argument on what you know, not what you think other people don't know.

i respond to what i read... if you don't agree, then ignore it!

i do have a question for you, that i believe will clear up where i am coming from...

let's say there is a basic, who has as you say recognized the need to use the BVM... he has a good seal, knows the rate... however, you notice that the reservoir bag has not been used... DO YOU HAVE AN ISSUE WITH THIS??

i will await your answer.

 

[Explorer127]

woah, this is wayyy more controversal than i thought it was gonna be... i just wanted to know a little about using a bvm on a conscious pt.

lol

btw, the question's been answered.

except for one part....can u use a face mask if u don't have bvm with u?

i know someone's gonna sayy something about the oxygen percentage stuff.. i know a facemask only gives 16%, and a bvm can give either 21% or 99-100%....but if a facemask is all u have wouldn't it be better than nothing?

 

[VentMedic]

btw, the question's been answered.

except for one part....can u use a face mask if u don't have bvm with u?

What type of face mask?

One made for CPR rescue breathing, yes, if necessary but could be awkward depending on level of consciousness.

For oxygen masks like a simple or NRBM, that depends on the rate and quality of breathing being done by the pt.

 

[Explorer127]

yea, i was talking about a cpr mask. thanks

 

[EMTDON970]

Bvm

I have "bagged" many conscious patients.