color, this person will be pale well oxygenated or not. he will be shunting blood. if you mean cyanotic then yes i agree bag.
1.) spo2 may read 97 percent but what is the body doing to acheive this, how much is it compensating and how is this affecting the vitals? 2.) what about secondary injuries, this is a very real possibility. hemmorhage?tamponade?pulm injuries? how are these affecting your "triad"
3.) LOC- nobody will be mentating properly here so does that indicate NRB or BVM? what will the effect of this be? hyperoxygenation or hypocapnea?
4.) irregular breaths- irregular doesnt necessarily mean ineffective and these pt's can had very strange breathing patterns that seem great than 10 seconds later then really shallow/deep or tachy/brady. whats acceptable?
those are some of my questions... I go NRB on these pt's (head injuries, dont really see the whole triad very often) and wait for signs that i need to bag. traumas dont seem to need it as often as strokes do for me..funny now that i think about it
Those are some excellent questions!
1.) SpO2 can be the devil! It is a great tool but not without it's flaws. Perfect example was a pt of mine yesterday. Pt presented w/ respiratory distress- respirations 28 labored and bi-lateral lungs presented w/ rales (hx CHF). SpO2 read 92%....
The pt presented w/ a sympathetic response. Sinus tach around 110 (pt was also on a beta blocker), skin ashen in color w/ pale conjunctiva and mucosa, cool, slight diaphoresis, and cyanosis was noted to her fingertips. The pt's increased respiratory rate and exertion were maintaining the O2 saturation but a pt can only do that for so long....
Yes, shock will throw vitals askew, especially if you go in expecting to see vitals associated w/ a certain condition (ex- Cushings Triad). If a pt has head trauma think ICP, regardless of the vitals.
2.) Secondary injuries also will debunk any predetermined diagnosis based on "syndromes" that rely on a vital sign like Cushings or Becks. Most pt's w/ significant head trauma or thoracic trauma w/ be treated as multi-system trauma and present as such.
3.) If a pt is unconscious/unresponsive an airway w/ assisted ventilations will be provided. A BLS provider should insert a basic adjunct and assist ventilations if the unconscious/unresponsive pt presents w/ respiratory distress or respiratory failure. The pt will be hyper-oxygenated due to the supplemental O2 but that's the point. To be ahead of the 8 ball. Hypocapnia can only be determined by pre-hospital by ETCO2. If you hyperventilate a pt they will be hypocapnic. Obvious signs of brain herniation should be the only time this method of assisted ventilations should be utilized in a attempt to reduce or "slow down" ICP. Medical control should be contacted before preformed unless a protocol is in place.
4.) Irregular or inadequate is not acceptable. Every pt is different and if the pt appears to be experiencing inadequate tissue perfusion from such, then assisted ventilations should be considered/preformed.
