Forgot oxygen

[Tigger]

I won't use oxygen for comfort, but I have definitely used it for placebo effect for pain control. Placebo effect can be a very strong and if I'm in pain, my healthcare provider is welcomed to palcebo the hell out of me.

Though, as more and more literature comes out about the dangers of O2 administration, I do this very rarely nowadays.

The less you do that, the better. Oxygen is indicated for cases of respiratory distress, not for any sort of pain control, placebo or not! You might think it's helping but odds are the patient is less comfortable (ever had an NC for extended period of time) and you are costing them more money. Never mind the whole ethics and breaching the trust of patients issue.

There are BLS pain control measures. Proper positioning, cold and heat packs, blankets, pillows, splinting, and even holding the patient's hand are all more effective than supplementary oxygen.

 

[Sasha]

I actually wasn't being sarcastic. I'd love to have a simple face mask for hospice patients who are mouth breathing but don't require the o2 flow rate for an NRB.

 

[AnthonyM83]

The less you do that, the better. Oxygen is indicated for cases of respiratory distress, not for any sort of pain control, placebo or not! You might think it's helping but odds are the patient is less comfortable (ever had an NC for extended period of time) and you are costing them more money. Never mind the whole ethics and breaching the trust of patients issue.

There are BLS pain control measures. Proper positioning, cold and heat packs, blankets, pillows, splinting, and even holding the patient's hand are all more effective than supplementary oxygen.

During the time when I did this, it was indicated for hypoxia, chest pain, respiratory distress, hypoperfusion, nausea, and others.

As far as ethics, it was within protocol that every patient got oxygen anyway (stupid protocol). I don't feel it was a breach of trust, either. I was doing something I was required to do anyway, but told them an additional benefit. The BLS pain controls you mentioned rarely relieved the pain. I also spent a long time studying placebo, hypnotic suggestions, alternative pain relief, etc. Both on my own and under guided supervision in a formal clinical setting.

The phrases I would use would be similar to "This is going to help you, okay? Let me know when you can feel the difference." Hand holding most definitely had a strong effect too.

 

[the_negro_puppy]

I actually wasn't being sarcastic. I'd love to have a simple face mask for hospice patients who are mouth breathing but don't require the o2 flow rate for an NRB.

You guys don't carry the 'Hudson" 50% masks that you can run on 4-8 L/m then?

 

[Tigger]

During the time when I did this, it was indicated for hypoxia, chest pain, respiratory distress, hypoperfusion, nausea, and others.

As far as ethics, it was within protocol that every patient got oxygen anyway (stupid protocol). I don't feel it was a breach of trust, either. I was doing something I was required to do anyway, but told them an additional benefit. The BLS pain controls you mentioned rarely relieved the pain. I also spent a long time studying placebo, hypnotic suggestions, alternative pain relief, etc. Both on my own and under guided supervision in a formal clinical setting.

The phrases I would use would be similar to "This is going to help you, okay? Let me know when you can feel the difference." Hand holding most definitely had a strong effect too.

Hand holding has a strong effect and has the added benefit of not being a medication like oxygen, which despite our initial education to the contrary, does have drawbacks in its use. I'm not super choosy about who gets 02, if I think there is some sort of respiratory compromise I'll ask the patient if they would like something to help their breathing (assuming a non-serious patient). But sadly, for a truly patient in a lot of pain, there is no medication that I can give to change that and I refuse to place someone on oxygen just so that it looks like I am doing something.

 

[Tigger]

You guys don't carry the 'Hudson" 50% masks that you can run on 4-8 L/m then?

I wish we did, but so far as I can tell most states do not require them to be carried, so they are not. We can take people from a facility with them already on of course.

 

[AnthonyM83]

I refuse to place someone on oxygen just so that it looks like I am doing something.

Agreed on that point.
Even in the placebo days, I never gave it to "shut them up" or "look good". It was for a specific intentioned purpose. My friend on the other hand was better at verbal pain control than I was. Through guided imagery and those sorts of techniques once had a femur fracture pain free. Wouldn't believe it till you saw it. He now makes a living doing alternative pain control. In other words, we were serious about giving mental suggestions to alleviate pain...not just screwing with patients...

 

[jjesusfreak01]

Agreed on that point.
Even in the placebo days, I never gave it to "shut them up" or "look good". It was for a specific intentioned purpose. My friend on the other hand was better at verbal pain control than I was. Through guided imagery and those sorts of techniques once had a femur fracture pain free. Wouldn't believe it till you saw it. He now makes a living doing alternative pain control. In other words, we were serious about giving mental suggestions to alleviate pain...not just screwing with patients...

Ahh, the "Mentalist" method...

 

[xrsm002]

Treat the patient NOT the pulse ox.

 

[mycrofft]

Especially if the pulse ox doesn't work. :deadhorse:

 

[the_negro_puppy]

Treat the patient AND other assessment tools including SP02, EtC02, GCS, RR, lung sounds

 

[JPINFV]

Treat the patient AND other assessment tools including SP02, EtC02, GCS, RR, lung sounds

 

[Christopher]

Treat the patient NOT the pulse ox.

The dead horse you're beating here is our credibility as providers.

Obviously you treat the the patient...this is what a clinician does. Assessment of the patient includes qualitative and quantitative measurements obtained through a history, physical assessment, and tools available to you as a provider.

Please never use that phrase again, for the sake of our profession.

 

[Handsome Robb]

Treat the patient AND other assessment tools including SP02, EtC02, GCS, RR, lung sounds

The dead horse you're beating here is our credibility as providers.

Obviously you treat the the patient...this is what a clinician does. Assessment of the patient includes qualitative and quantitative measurements obtained through a history, physical assessment, and tools available to you as a provider.

Please never use that phrase again, for the sake of our profession.

Clinical correlation, say what?!?!?!?

 

[mycrofft]

Which phrase, "treat the patient", or "beat the dead horse"? Or "credibility as providers"?

 

[AnthonyM83]

Treat the patient NOT the pulse ox.

No, treat both....

 

[xrsm002]

That's what my I instructor I've had for the past year has drilled into my classss head treat the patient not the devices. This was especially true during cardiology class.

 

[xrsm002]

Still of the pulse ox is reading 90% on a respiratory distress I will give oxygen.

 

[JPINFV]

That's what my I instructor I've had for the past year has drilled into my classss head treat the patient not the devices. This was especially true during cardiology class.

So your female diabetic patient is complaining of no pain yet has ST elevation, do you treat the monitor and call it a STEMI or treat the patient and do... nothing?

Your patient doesn't have any respiratory distress, but has a SpO2 of 89, do you start supplemental oxygen or do nothing?

 

[jwk]

So your female diabetic patient is complaining of no pain yet has ST elevation, do you treat the monitor and call it a STEMI or treat the patient and do... nothing?

Your patient doesn't have any respiratory distress, but has a SpO2 of 89, do you start supplemental oxygen or do nothing?

I'd be much more concerned about the first patient than the second.

HOWEVER...

The sentiments about NOT treating the monitor/number are correct. You have to take all the clinical informatin you have and put it altogether. If you simply treat a number or an EKG trace, all by itself, with no other data to correlate it with, then you're foolish.