emtfarva
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It is not about forcing it down, it is about keeping the bag full. If you can keep the bag full at 10 l then use 10.
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reaper
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Yes, some NH pt's need more O2, but you may only have 10 pt's a year that really need a NRB @ 15L. EMT's are pushed on High Flow O2 and that is the biggest joke of all!
DevilDuckie
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Exactly, that's what I do.. I just don't believe in giving every patient "High Flow O2", it's like the instructors are too lazy to teach anything else.
Asking questions is the best way to test one's knowledge.
Where to begin with O2 therapy?
An O2 concentrator scrubs the Nitrogen from the air and leaves behind the O2. Units can deliver between 50 - 95% O2.
However, do you know what determines the amount of inspired FiO2 for either a NC or NRBM?
DevilDuckie
A NRBM is by definition not a high flow O2 device. EMT(P)s just got into the habit of saying that since it sounds like a whole bunch of O2 when you say 15L/m and that is the definition EMS providers have adopted. Unfortunately this makes it very difficult to teach the very basic prinicples of CPAP, ventilators or just ventilation. It can hard to retrain someone into a more scientific and appropriate definition.
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And it wasn't till about two years ago that Basics in my area were allowed to give anything OTHER than 15LPM via NRB per protocol.
AJ Hidell
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Wonderful. But were you taught the physiological basis for doing so? Were you taught how to determine how much they need, when they no longer need it, and the pathophysiology of why they needed it in the first place? Your questions indicate that this may not have been the case.
DevilDuckie
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I'm a fan of the simple mask my self.
That piece of junk needs to be banished. Who only has a minute volume of 6 - 10 L if they are an adult and if they are in distress? I have used one in 5 years in the hospital and definitely not on Flight.
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Sasha
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Don't mind him, he's just trying to up his post count.
What device in the hospital/flight do you use to deliver high flow oxygen?
reaper
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I have not seen one on an ambulance in years?????
The OxyMask which can go from 1L to 15L using the same device.
For comfort in the hospital, we may use a High Flow NC which can go up to 32 Liters per minute. There is also a model that can go up to 40L/min.
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Sasha
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Doesn't that dry out their nose pretty bad?
Heated humidification close to the body's norm....
If you blow hard against your hand, that is about 350 - 400 L/M but you don't feel it because it is warmed and humidified to a tolerable level by your body.
i have a question. it seems like regardless what i do, it seems wrong. i've came across a COPD pt with diff breathing(according to the NH). They are on 2LPM O2 via NC with sat's at 86 and RR at about 26/min. now here is where i have a problem. do you leave them on the canula at 2LPM, or do you put them on a NRB and up the flow. i've txp with the canula and when we got to the er they put them on NRB and i've txp after putting them on NRB and got to the er where they put them back on canula. granted i do know that high flow O2 is bad for COPDer's but my understanding was that if it was bad only if you had them on high flow for an extended period of time.
Never withold oxygen.
There are two differnet kinds of COPD pts.
Some rely on hypoxic drive, others rely CO2.
In theory if you give to much oxygen to a pt that relies on hypox drive you can cause the to to stop breathing.
Most COPd pts rely on CO2. So it shouldnt be an issue.
The best answer is to titrate the O2 till the pt is comfortable. These people usually live in the high 80's low 90's. So there is no need for SPO2 of 99%. Just until comfort is achieved
There are two differnet kinds of COPD pts.
Some rely on hypoxic drive, others rely CO2.
In theory if you give to much oxygen to a pt that relies on hypox drive you can cause the to to stop breathing.
Most COPd pts rely on CO2. So it shouldnt be an issue.
The best answer is to titrate the O2 till the pt is comfortable. These people usually live in the high 80's low 90's. So there is no need for SPO2 of 99%. Just until comfort is achieved
medic417
The Truth Provider
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Wow surely you joke. Even as a first responder many many years ago I could place on O2 based on need rather than a set amount.
right i would usually only put them on 10lpm and their sat's would usually go up to about 95 and i'd be happy with that.
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Sasha
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How often do you have a patient that actually requires high flow oxygen as oppose to a cannula at 2lpm? Is that something they'd continue after discharge from the hospital?
Right. Just keep them oxygenated.
Ridryder911
EMS Guru
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I'll throw a monkey wrench into it. How about a Venturi mask? I am sure most were never shown or taught these as well. Personally, I found them much tolerable for COPD patients as well as having the ability to know what percentage I am administering.
Vent I have not seen them used in years in both settings. Was there a problem with them, that I was not aware of or they fell out of favor due to newer devices?
In regards to not being taught "15 lpm NRBM"; I don't think its about being lazy. Rather the emphasis is if you want your student to pass the written/practical they better answer such. Again, the reason is because the lack of education the EMT recieves and is perceived it is much better to see the patient with oxygen than without. As I had seen many patients arrive with oxygen per NRBM re-breathing their own Co2.
The other reason is much more simpler. It is doubtful many of the EMT instructors know much better themselves. As it does not require much to become one; other than an 39 hour instructor course and maybe experience requirements.
R/r 911
Vent I have not seen them used in years in both settings. Was there a problem with them, that I was not aware of or they fell out of favor due to newer devices?
In regards to not being taught "15 lpm NRBM"; I don't think its about being lazy. Rather the emphasis is if you want your student to pass the written/practical they better answer such. Again, the reason is because the lack of education the EMT recieves and is perceived it is much better to see the patient with oxygen than without. As I had seen many patients arrive with oxygen per NRBM re-breathing their own Co2.
The other reason is much more simpler. It is doubtful many of the EMT instructors know much better themselves. As it does not require much to become one; other than an 39 hour instructor course and maybe experience requirements.
R/r 911