Forgot oxygen

The only place supplemental oxygen shouldn't be used is near Berkeley.


...they already have enough free radicals.
 
JPINFV said:
The only place supplemental oxygen shouldn't be used is near Berkeley.


...they already have enough free radicals.
Click to expand...

*rimshot*

But actually, that gave me a good chuckle.

And in all seriousness: if you're administering oxygen to everybody, you're doing something wrong.
 
The BLS folks look at me like I'm crazy when I take the oxygen mask off of the patients.

I just smile and tell them I'll explain later. :)

Most times, when I use oxygen, its only to drive a neb or CPAP.
 
My favorite is when you see people take a baseline O2 sat while the patient is on a NRB cranked up to 15 LPM.
 
So let's consider:

Say there isn't a recent studying supporting that oxygen helps with a certain medical complaint. But it's either a local standard OR they were taught to do so by an instructor or textbook.

At what point do they stop using oxygen for that complaint? Once the study is a certain number of years old? If there is three, but not four studies on it? If only two out of the main four textbooks instruct it? Could the EMT ever be found at fault for not applying it in these circumstances?

Take the nasal cannula for oxygen. As a new EMT, I was taught it helped for nausea. There were a couple studies showing that oxygen reduced nausea. I used it for some nausea patient and a certain number of them said it reduced the nausea (no way to know how they would have felt without the oxygen). Is this EMT now wrong for continuing this process a few years later?

Now I'm a HUGE HUGE proponent of evidence based medicine. But being devil's advocate here too. Want to throw in some realism. There are a lot of things studies haven't been done on. Should a practice be discontinued completely? What if personal experience supports it, but there's no study to support/refute it?

It reminds me of that article about how now there have been no double blind randomized studies to show the effectiveness of the use of a parachute when skydiving. There is no solid evidence to promote the routine use of parachutes when skydiving. Screw experience altogether?

http://www.bmj.com/content/327/7429/1459.long

It was at least an important enough "consideration" to write a tongue in cheek article that got actually published...
 
Well I think some of the problems stem from the amount of oxygen that EMTs are taught to apply. It's either 2 L via nasal cannula or 15 L on a non-rebreather. Never mind that the patient has a respiratory rate of 18, an end tidal CO2 reading of 40 and an SpO2 of 97%... If the patient expresses that they're having difficulty breathing, most EMTs put oxygen on that patient, in my experience, usually by mask at 15 L.

That patient may only be experiencing anxiety due to the situation that they're in… Not true respiratory distress. Or the patient who experienced a syncopal episode.. The majority of those patients do not require oxygen, although I see them with a mask strapped to their face every time.

I asked the EMTs why are they on oxygen and the response is invariably, "because they need it". It's simply a matter of poor education and teaching to the test, rather than explaining the action and reasoning behind the oxygen use.

I would bet if you took any new EMT and ask them how much oxygen a "medical" patient gets, they'll tell you 2 to 6 L via nasal cannula. Ask about a "trauma patient", they'll tell you 15 L on a mask. No if's, ands or buts. And they'll bust out the gem about how "oxygen will kill a COPD patient".

I try to do a little reeducation when I can, and most of the BLS crews I work with now don't put oxygen on a patient and less they clinically need it. Isn't that what were striving for?
 
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