Let's just take oxygen out of standing orders.

NYMedic828

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Ok I know that's completely absurd in reality but I'm sick of almost everyone I work with putting all my patients on oxygen by one method or another.

The nurse looked as us like we were mentally challenged yesterday because we had someone who was otherwise completely asympomatic on o2.

People get mad at me when we call a trauma note, they open the back doors and I have our patient on room air...

Oxygen is NOT the duct tape of EMS, when will people get it?

Atleast if you had to call a doctor for permission (which I realize is completely ridiculous in reality I'm just ranting) then there would be someone to tell the provider stop being an incompetent moron and transport...

Again I am just ranting I realize this would be a completely impractical change.
 

rennex

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That's because step 2 in like every protocol we have is "Administrate Oxygen" :blush:

Edit: In NYC.
 

WolfmanHarris

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I'm about to incriminate myself:
The Ontario BLS standards (All our delegated medical acts fall under ALS standards) still list a huge number of generic patient types requiring high concentration oxygen within two minutes of patient contact. The BLS standards haven't had a rewrite in years and are extremely dated in medicine and approach.

BLS standards require high concentration oxygen on all chest pains despite the mounting evidence and AHA best practice to the contrary. I decided awhile ago that i'd had enough and switched to nasal prongs titrated to SPO2.

My approach now is that if the standard is so far behind medicine as to be irrelevant then I might as well disregard when in the best interests of my patient, medically justifiable and within my medical directives.
 

WolfmanHarris

Forum Asst. Chief
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I'm about to incriminate myself:
The Ontario BLS standards (All our delegated medical acts fall under ALS standards) still list a huge number of generic patient types requiring high concentration oxygen within two minutes of patient contact. The BLS standards haven't had a rewrite in years and are extremely dated in medicine and approach.

BLS standards require high concentration oxygen on all chest pains despite the mounting evidence and AHA best practice to the contrary. I decided awhile ago that i'd had enough and switched to nasal prongs titrated to SPO2.

My approach now is that if the standard is so far behind medicine as to be irrelevant then I might as well disregard when in the best interests of my patient, medically justifiable and within my medical directives.
 

bigbaldguy

Former medic seven years 911 service in houston
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I'm sick of almost everyone I work with putting all my patients on oxygen by one method or another.

Aren't most them technically on oxygen already :)
 

bigbaldguy

Former medic seven years 911 service in houston
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They could just do what they did on airplanes. The highest flow rate for our O2 tanks on the plane is 4 lpm on a non re-breather. It's kind of like holding a pillow over their face :) great for hyper-ventilators I suppose.
 

shfd739

Forum Deputy Chief
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Yeah Im always aggravating first responders and some of our folks when I take the O2 off their patients..Its fun to see the reactions. Then I educate them.

Most recent was a kidney stone patient @99% room air and they were putting on a cannula @ 4lpm..When asked why the crew said "well he's short of breath"..No, he is in pain- give your fentanyl and it will get better...and I took the cannula away.
 

Ridryder911

EMS Guru
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In lieu of removing it from standing orders... how about educating them right the first time?... As most fail to remember; oxygen is a drug .. and drug(s) need to be used accordingly and properly and as well..... have a physician authorization.
 

DrParasite

The fire extinguisher is not just for show
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Ok I know that's completely absurd in reality but I'm sick of almost everyone I work with putting all my patients on oxygen by one method or another.
your complaint is unfair, and your anger is misplaced. RR said it before I could:
In lieu of removing it from standing orders... how about educating them right the first time?
If you tell someone that everyone needs oxygen when they are first trained, that's what will happen. Trauma's need oxygen, medical's need oxygen, and all your protocols say apply high flow oxygen, guess what every provider will do? and even better, if your bosses/ER doctors are going to file complaints when you don't apply oxygen, what's your defense going to be? "I know it's in the protocol, and my medical director wants me to do it, but I know more than they so I just won't do it." I don't think it will go over quite as well as you hope.

Please don't misunderstand, I agree that we over oxygenate people in EMS. but changes needs to start at the top, at the medical director level, and the state protocol level, and the education level. You can't call someone stupid for following the directions of his or her state protocol, or medical director, or what what drilled into their head in school can you?
 

the_negro_puppy

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Our oxygen protocols have changed dramatically over the past few years. We only use it if its clinically indicated and even then its titrated for effect.

As a rule ACS and strokes don't get oxygen unless there is a problem with their oxygenation.
 

JPINFV

Gadfly
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In lieu of removing it from standing orders... how about educating them right the first time?... As most fail to remember; oxygen is a drug .. and drug(s) need to be used accordingly and properly and as well..... have a physician authorization.


...because we can't have that edujmacation things in EMS... especially at the EMT level.
 
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NYMedic828

Forum Deputy Chief
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your complaint is unfair, and your anger is misplaced. RR said it before I could:
If you tell someone that everyone needs oxygen when they are first trained, that's what will happen. Trauma's need oxygen, medical's need oxygen, and all your protocols say apply high flow oxygen, guess what every provider will do? and even better, if your bosses/ER doctors are going to file complaints when you don't apply oxygen, what's your defense going to be? "I know it's in the protocol, and my medical director wants me to do it, but I know more than they so I just won't do it." I don't think it will go over quite as well as you hope.

Please don't misunderstand, I agree that we over oxygenate people in EMS. but changes needs to start at the top, at the medical director level, and the state protocol level, and the education level. You can't call someone stupid for following the directions of his or her state protocol, or medical director, or what what drilled into their head in school can you?

Can I hold them accountable for doing what they were told, by other incompetent people made instructor? No.

Can I hold them accountable for not self educating to understand what is truly right. Absolutely. And I do.
 
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NYMedic828

Forum Deputy Chief
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Can you elaborate a little on this? Still learning here.

AHA i believe suggests there is no immediate need for supplemental oxygen at O2 saturations of 94% or greater in the absence of respiratory distress.
 

mycrofft

Still crazy but elsewhere
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That's because step 2 in like every protocol we have is "Administrate Oxygen" :blush:

Edit: In NYC.

There you go. Anyone with the educational level to order "administrate oxygen" ...sort of like "getting orientated" (oriented).

I teach for a company that also sells oxygen and I am required to teach them to start O2 no matter what. Fixed at six liters, nonetheless....
 

mycrofft

Still crazy but elsewhere
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In lieu of removing it from standing orders... how about educating them right the first time?... As most fail to remember; oxygen is a drug .. and drug(s) need to be used accordingly and properly and as well..... have a physician authorization.

Yes that! A tool is a tool, whether it is oxygen or the "administrationater".;)
 

the_negro_puppy

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Our protocols lol :p

 

mycrofft

Still crazy but elsewhere
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How is "SpO2" measured in the field? (Pulse Ox I assume. Never know what you folk downundah are going to be doing next).
 
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mycrofft

Still crazy but elsewhere
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We actually had for a short time a device that read haemoglobin on a reagent strip like a urine dipstick. Pre-pulse ox
 

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