IFT Trach Patients by BLS.

[redundantbassist]

Not necessarily there is always cap refill. You could walk into a house fire and come out with a saturation of 100% it's just like Private ALS companys in LA county not being able to pace unless having a special certification from the county and as well no requirement for cpap and also having to have a special certification from the county even though BOTH are taught in school.

Likewise, I feel that having a pulse oximeter discourages the mindset of "give everyone o2 no matter what" mentality that is ever so prevalent in the BLS community.

A patient who has an arm injury and has no signs of respiratory distress or hypoperfusion would most likely not need oxygen, and this would be confirmed by obtaining an spo2. On many conditions, providers at the BLS level would give such a patient o2 due to the fallacies in their limited training and protocols.

 

[gonefishing]

Likewise, I feel that having a pulse oximeter discourages the mindset of "give everyone o2 no matter what" mentality that is ever so prevalent in the BLS community.

A patient who has an arm injury and has no signs of respiratory distress or hypoperfusion would most likely not need oxygen, and this would be confirmed by obtaining an spo2. On many conditions, providers at the BLS level would give such a patient o2 due to the fallacies in their limited training and protocols.

Exactly but there are some that state theres a ton of education to follow using a pulse ox which is BS I learned caponography in a day and think its one hell of a tool. EMS in certain areas especially where its fire controlled beleive in the KISS system. (Keep It Simple Stupid) which only results in holding ems back education and skill wise.

 

[redundantbassist]

Exactly but there are some that state theres a ton of education to follow using a pulse ox which is BS I learned caponography in a day and think its one hell of a tool. EMS in certain areas especially where its fire controlled beleive in the KISS system. (Keep It Simple Stupid) which only results in holding ems back education and skill wise.

Stupid protocols are written by stupid people.

 

[gonefishing]

Stupid protocols are written by stupid people.

Well it's to protect stupid people. Back in the mid 90's a LA Firefighter Emt improperly used smelling salts on a patient. He shoved 1 in each nostril pinched and cracked the vials in the patients nose leading to a major lawsuit. As they say Jack of all trades master of none.

 

[redundantbassist]

Well it's to protect stupid people. Back in the mid 90's a LA Firefighter Emt improperly used smelling salts on a patient. He shoved 1 in each nostril pinched and cracked the vials in the patients nose leading to a major lawsuit. As they say Jack of all trades master of none.

I feel bad for laughing at that image

 

[Tigger]

Back in the mid 90's a LA Firefighter Emt improperly used smelling salts on a patient. He shoved 1 in each nostril pinched and cracked the vials in the patients nose leading to a major lawsuit.

 

[johnrsemt]

You don't need pulse ox to decide if the patient needs O2 or not, just like you don't need Blood Glucose reading to decide if your patient needs Oral Glucose or D-50.
What if your batteries in the glucometer die? Pt is confused, and diaphoretic and family says that he is acting like he does when his sugar is low: You are going to treat him.
O2: My normal Pulse ox is 92%, but I don't need O2 on a normal basis. When my asthma is acting up my Pulse ox goes up to 98-99% at first, but I might need O2. Then it drops when asthma gets bad. If you treat me by Pulse ox readings; you will give me O2 on a good day and withhold it when I need it.

TREAT THE PATIENT NOT THE MONITORS

 

[ERDoc]

You don't need pulse ox to decide if the patient needs O2 or not, just like you don't need Blood Glucose reading to decide if your patient needs Oral Glucose or D-50.
What if your batteries in the glucometer die? Pt is confused, and diaphoretic and family says that he is acting like he does when his sugar is low: You are going to treat him.
O2: My normal Pulse ox is 92%, but I don't need O2 on a normal basis. When my asthma is acting up my Pulse ox goes up to 98-99% at first, but I might need O2. Then it drops when asthma gets bad. If you treat me by Pulse ox readings; you will give me O2 on a good day and withhold it when I need it.

TREAT THE PATIENT NOT THE MONITORS

No, this is all wrong. This is why EMS as a whole is stuck in the 70s. If the monitors didn't have any value or add anything to pt care then we wouldn't use them. There is a reason we have developed all of these monitors and that is to provide better pt care. Yes, you need a glucose reading to know if you are treating a hypoglycemic or a stroke. I don't care what the family says, people with hypoglycemia can have other things wrong, including strokes and stroke mimics. Are you going to give D50 to someone in DKA? When your asthma is "acting up" and your pulse ox is 98%, you don't need oxygen, you need albuterol and atrovent. Why would anyone give you oxygen on a good day? A pulse ox of 92% is no reason for oxygen.

The monitors are an integral part of pt care. They become an extension of the patient and an extension of the provider. They fill in so much detail of the overall picture that to dismiss them as not needed is to demonstrate that their purpose, function and use is poorly understood.

 

[Carlos Danger]

Yeah, monitors are just a scam....patients got waaay better treatment before we got duped into buying all these these fancy 'ometers and 'oximeters.

Amiright!?

D50 for all the stroke patients!!!!

 

[Tigger]

Clinical correlation.

 

[systemet]

Yes, you need a glucose reading to know if you are treating a hypoglycemic or a stroke. I don't care what the family says, people with hypoglycemia can have other things wrong, including strokes and stroke mimics.

To expand on this for some of the newer BLS providers, you will see plenty of old people, many on beta-blockers who don't present with typical symptoms when they're hypoglycemic. You will see overdoses on insulin or oral hypoglycemics, and many other drugs (e.g. propanolol) that become hypoglycemic. You will meet people who are drunk, overdosed on opiates, and have head trauma who are also hypoglycemic. You will certainly see tons of sick kids that have hypoglycemia as a contributing factor. You will see hypoglycemic with lateralised deficits.

Not to even get started on hypoglycemia. I had a guy yesterday who presented as drunk and tachycardic, whose glucose was 35 mM ( 650 mg/dl). Want to send him to the drunk tank? Or the local homeless shelter?

When your asthma is "acting up" and your pulse ox is 98%, you don't need oxygen, you need albuterol and atrovent. Why would anyone give you oxygen on a good day? A pulse ox of 92% is no reason for oxygen.

Not to mention, sometimes you look at the patient, and that don't seem that bad, then you look at the monitors, and you go, hey, while this guy is compensating, objectively he's probably much worse than I think. Let's re-evaluate where we're sitting.

That's why things like PRAM scores ( http://www.albertahealthservices.ca/Information For/if-hp-emerg-nurs-educ-ped-asthma-pathway.pdf ) exist. Because there's a whole lot of research that goes into how we treat people, and is used not just by EMTs, RNs and Paramedics, but also by the Physicians. If they're doing it, maybe we should, too?

 

[Rano Pano]

Yeah, monitors are just a scam....patients got waaay better treatment before we got duped into buying all these these fancy 'ometers and 'oximeters.

Amiright!?

D50 for all the stroke patients!!!!

 

[medichopeful]

TREAT THE PATIENT AND THE MONITORS

Fixed it for you!

Monitors and other assessment tools are there for a reason. They provide information that should be used to provide an overall clinical picture. If the monitor is saying something funky that doesn't seem to fit, the information shouldn't be simply thrown out, but rather looked into further.

That being said, if the monitor is saying something completely false (first thing that pops into my head is asystole when you're talking to them), than I would say it's safe to take it with a grain of salt . However, that's different than simply saying "treat the patient not the monitor."

 

[hogwiley]

It's not rocket science, cnas do it all the time, however you should be trained on how to do it, in as sterile a manner as possible. They can have a stubborn mucus plug, so it's good you are cautious, it means you're a conscientious emt. It's the overly confident yet inexperienced emts that scare me.

Why not ask the rt or medic how to do it when they were doing it?

Also you should know what to do in the case of decannulation, especially if they have an altered mental status or dementia. Trachs have an inner cannula and outer cannula. Inner canula coming out not a huge deal. Outer cannula coming out can be, especially if it's a relatively recent trach(in which case it wouldnt be bls).

 

[RocketMedic]

Not necessarily there is always cap refill. You could walk into a house fire and come out with a saturation of 100% it's just like Private ALS companys in LA county not being able to pace unless having a special certification from the county and as well no requirement for cpap and also having to have a special certification from the county even though BOTH are taught in school.

How many flaming/CO poisoning nursing home patients do these private ALS companies run?

 

[hogwiley]

I've never understood not letting bls use a pulse ox. Just educate them that a low spo2 reading can be the result of poor circulation so they don't freak out when a 92 year old gramps initially shows 74. Just try different fingers and toes and see if the reading is the same and if they are symptomatic.

They are useful tools and often the first thing I'd put on a patient while doing my assessment, seeing how it matched up with everything else I'm seeing while getting a baseline reading. They're supplemental tools and not definitive and that's pretty well driven home in emt school.

Companies just don't trust emts not to lose them and don't want to pay for them.