Forgot oxygen

[Notown]

According to my instructor, even if a patient does not necessarily need the O2, the placebo effect may make them "feel better" and help calm the situation. I'm not in the field yet but I've never really understood how that could be true. I would think that some patients would get more worked up and wonder why they need O2.:censored:

 

[Sasha]

According to my instructor, even if a patient does not necessarily need the O2, the placebo effect may make them "feel better" and help calm the situation. I'm not in the field yet but I've never really understood how that could be true. I would think that some patients would get more worked up and wonder why they need O2.:censored:

You'll find out that's a load of bull. A nasal cannula is not comfortable and it doesn't make a lick of difference half the time.

 

[Christopher]

According to my instructor, even if a patient does not necessarily need the O2, the placebo effect may make them "feel better" and help calm the situation. I'm not in the field yet but I've never really understood how that could be true. I would think that some patients would get more worked up and wonder why they need O2.:censored:

I'd like to quote Dr. Paul Matera (who may be quoting somebody else):

Don't just do something, stand there!

Just because you can doesn't mean you should. That being said, sometimes your patient just needs a little T.L.C. which may comprise of, "dear, I'm going to put this oxygen on your nose to make you feel better; so you're a little bit more comfortable for the ride. How many kids did you say you have again?"

 

[Sasha]

O2 IV and monitor for every transport is bad medicine and anyone who employs that should be ashamed that they're not capable of making decisions using their clinical judgement

 

[Christopher]

You'll find out that's a load of bull. A nasal cannula is not comfortable and it doesn't make a lick of difference half the time.

It certainly doesn't at less than 2 L/min

22% FiO2 at 2 L/min...20.8% in the air they're breathin', hmmm.

 

[NYMedic828]

According to my instructor, even if a patient does not necessarily need the O2, the placebo effect may make them "feel better" and help calm the situation. I'm not in the field yet but I've never really understood how that could be true. I would think that some patients would get more worked up and wonder why they need O2.:censored:

This is where the problem lies.

We have all these instructors with no clinical judgement or decision making capability of their own telling people to operate like robots, just because they can.

If I have a patient with no respiratory complaints and an O2 sat of 98%+ , what am I achieving? Its impossible to break 100% O2 sat, there is no going the extra mile. (granted o2 sat is not a definitive measure of oxygenation, just using it as an example)

Oxygen also tends to dry out the mucus membranes and makes a lot of people uncomfortable. Other people don't like having a mask on their face or something in their nose.

Doing it just to do it is stupid.

Lack of oxygen is rarely the problem your patient is going to be experiencing. COPD/Asthma/APE these are oxygenation issues. Abdominal pain and injuries are not.

 

[Aidey]

I have been on a nasal cannula before, due to being consciously sedated. It was on 2lpm, and it smelled disgusting and was annoying as all heck. There was nothing comforting about it.

 

[mycrofft]

OP, the issue is you forgot something you were supposed to bring. Next time it's the EKG? (Naw, not after going through this on EMTLIFE!).
:deadhorse:

I have taught for an unnamed company which also markets oxygen equipment. Want to bet they tell clients in class to use O2 whenever?

I think in most instances it is an unnecessary expense and maybe clinically unnecessary, but essentially harmless. The length of time ambulance patients in urban/suburban situations are on it is not very long, and if it was that harmful we'd have dead people stacking up next to the piles for the victims of rubber and peanut allergies.

The issues are why protocols are not written to reflect reality as we have it now, and why EMS people are seen as being stupid enough to require lowest common denominator protocols?

PS: I think bstone's initial thrust was to BRING the triad because they are OFTEN necessary and going back for them is bad form, especially if the pt has just coded. Also, in his system and experience maybe most of the pts DID or DO require O2, and not so many owes etc.

 

[TatuICU]

But I.V's save lives! :sad:

Not knocking intermediates, but I think a lot of people who have such a minimally expanded scope try to excercise it as much as possible. And they get away with it, because its hard to ding someone if it isn't truly harmful to the patient. You can always use your "I was airing on the side of benefit to the patient" get out of jail free card.

Same can be said for every level if provider. That's why we recently fired someone for pushing atropine on a patient with an inferior wall MI with a rate of 45 with a 95/ 52 blood pressure.

Sometimes the best thing to do with your hands is sit on them.


As far as the every call getting o2, blah blah blah, that's garbage and just bad medicine, however that's how some companies bill apparently.

 

[Christopher]

If I have a patient with no respiratory complaints and an O2 sat of 98%+ , what am I achieving? Its impossible to break 100% O2 sat, there is no going the extra mile. (granted o2 sat is not a definitive measure of oxygenation, just using it as an example)

While you cannot break 100% saturation of hemoglobin, you can continue to increase the PaO2!

Which brings us to the cornerstone of effective use of pulse oximetry: understanding the Oxyhemoglobin Dissociation Curve. Basically, as you increase the partial pressures of dissolved O2 in the blood, your Hgb holds onto O2 more tightly. As you decrease the partial pressures of dissolved O2 in the blood, your Hgb more readily releases O2.

All you know (assuming no shift in the Hgb-O2 curve) with 100% SpO2 is that you have a PaO2 of at least 100 mmHg...you don't know where on the curve you are.

This is what has been shown to be harmful to your cardiac and stroke patients! You could have a PaO2 of 100, 150, 200 mmHg or even higher, you just don't know. Oxidative stress is going to increase the wider the gap is between metabolic demand and available oxygen. Going beyond ~98% (outside of preoxygenation for a procedure) isn't helpful, because you no longer know where you are on the curve.

But with say an SpO2 of 90%, again assuming no shift, you have a PaO2 of around 60 mmHg and now you're in danger of "falling off the cliff" as the curve is very steep. Partial pressures of oxygen in that range will allow the oxygen to more readily dissociate from Hgb. States like acidosis or hyperthermia will also cause your patient to shed bound-O2 more readily, even at higher SpO2's! Oops, I'm rockin' a tangent here.

Coming full circle: no respiratory complaint or distress? No need for O2.

 

[TatuICU]

I have been on a nasal cannula before, due to being consciously sedated. It was on 2lpm, and it smelled disgusting and was annoying as all heck. There was nothing comforting about it.

Same here while getting a chest tube. Was itchy and really distracted me from enjoying my versed and fent.

 

[Christopher]

Same can be said for every level if provider. That's why we recently fired someone for pushing atropine on a patient with an inferior wall MI with a rate of 45 with a 95/ 52 blood pressure.

If they blindly pushed the atropine because, "HEART RATE LOW! PARAMEDIC SMASH!!", then yeah...remediate/fire whatever.

Contrary to what most were taught, atropine is not contraindicated in higher degree blocks and often can be useful in an inferior wall MI. Again, tangent...my bad.

 

[Christopher]

OP, the issue is you forgot something you were supposed to bring. Next time it's the EKG? (Naw, not after going through this on EMTLIFE!).

Not bringing everything to the patient's side eventually means you're missing something important, usually when it's the least awesome to be missing it

 

[Doczilla]

This is why there were talks of ' cardiac arrest tanks' that has lower %o2. Anyone ever heard of that?

 

[Doczilla]

Same here while getting a chest tube. Was itchy and really distracted me from enjoying my versed and fent.

That's why I would have put you in a K-hole.

 

[Sasha]

If they blindly pushed the atropine because, "HEART RATE LOW! PARAMEDIC SMASH!!", then yeah...remediate/fire whatever.

Contrary to what most were taught, atropine is not contraindicated in higher degree blocks and often can be useful in an inferior wall MI. Again, tangent...my bad.

This made me lol.

 

[TatuICU]

If they blindly pushed the atropine because, "HEART RATE LOW! PARAMEDIC SMASH!!", then yeah...remediate/fire whatever.

Contrary to what most were taught, atropine is not contraindicated in higher degree blocks and often can be useful in an inferior wall MI. Again, tangent...my bad.

Why in the world would you increase the oxygen demand on an infarcting heart with a stable blood pressure? Most oftentimes the drop in rate is a protective mechanism.

Besides, if one has a good understanding of the pharmacokinetics of atropine and a good understanding of high degree infranodal blocks, the next question would be, why would you bother pushing it?

But you're right, this is tangential and not relevant to the thread. Happy to continue the discussion via pm or another thread.

 

[TatuICU]

That's why I would have put you in a K-hole.

Next bike race spot, Ft. Riley, KS

 

[JPINFV]

According to my instructor, even if a patient does not necessarily need the O2, the placebo effect may make them "feel better" and help calm the situation. I'm not in the field yet but I've never really understood how that could be true. I would think that some patients would get more worked up and wonder why they need O2.:censored:

1. Placebo effects are generally not considered ethical.

2. How would you like it if, using the set rate for one of the local counties, I charged you $80 (PDF) for a 10 minute placebo effect?

 

[EpiEMS]

2. How would you like it if, using the set rate for one of the local counties, I charged you $80 (PDF) for a 10 minute placebo effect?

I'm kind of a fan of that whole "charging for what we do" thing. Might make some folks think twice about putting O2 on pts who don't need it.