Need some clarification

Go with nonrebreather for most questions regarding air assistnace?

  • Yes and cover one eye

    Votes: 0 0.0%
  • Yes and cover both eyes

    Votes: 0 0.0%
  • No and cover both eyes

    Votes: 0 0.0%
  • No and cover one eye

    Votes: 0 0.0%

  • Total voters
    0

exitloy

Forum Probie
10
1
3
One of two things.

First, regarding impaled objects. My class EMT textbook (2016) states that you cover up BOTH eyes during an eye impalement, but notes not all EMS systems use that approach. A app i use online states that you only cover one eye.and i would hate to miss such a silly question over something i cannot find the "best" answer to.

Secondly, it seemed a lot of the test breathing was use a non-re breather (or what i thought anyway.) I'm not sure if the test question is evaluating my ability to recognize giving oxygen or weather or not to use a nasal cannula or nnonrebreather.. If O2 sats are given, would you go with nasal cannula if they were below 94% but above 90% and use a nonrebreather if they had O2 levels lower than 90%? Or based on the patients condition, you disregard the O2 saturation and go with nonrebreather as the question shows it "could maybe" be a heart attack or hypovolemic shock or whatever it may be, which i dont think nasal cannula would be the correct answer, but im unsure.

Another thing is airway and breathiing. I know its the first step, but so many questions say what should you do next and one of them is ventilate the patient or manage their airway. It almost seems as if its a trick question since every scenario basically starts of with airway then breathing ect considering the question is so much farther iin depth that it seems to be pointing to another intervention that should be recognized in the question.

Anyway, thank you in advance to anyone who can answer some of these questions, really appreciate it. Test this week.
 
Last edited:

Peak

ED/Prehospital Registered Nurse
1,023
604
113
So the idea behind co serving both eyes is that the patient won't look around with their uninjured eye that their injured eye would as well, and the movement against the object could cause further damage to the impaired eye. How effective this really is up for debate, I have never actually seen a study or recommendations by ophthalmology suggesting benefit to this. In my personal practice I have never covered the non-injured eye. Our primary goal in the emergency management on a globe rupture or laceration is to leave the object in place, prevent infection (antibiotics and covering the affected eye of appropriate), and preventing an increase in IOP (by giving pain control and anxiolysis, and avoiding drugs that increase IOP when possible).

Much of airway management comes from further education and experience. I won't pretend to give you any form of promise of a correct answer for NREMT (they live in their own world); generally patients who are unstable will get high flow oxygen and patients who only need a small amount of supplemental oxygen without other complicating presentations will get low flow. Stokes and MIs are actually one of the situations where we don't want to drive up plasma oxygen tension as it can cause vasoconstriction limiting coronary and cerebral perfusion, so in these cases we often titrate to around a SPO2 of 98%. Conversly there isn't the risk of oxygen in COPD that was once thought so high flow oxygen, especially for a short period of time in a patient with distress, so don't limit the patient to a nasal cannula; it isn't uncommon that COPD patients are intubated or put on BiPAP with an FIO2 of 100% for hours or days before we can titrate them back down in the ICU.

You need to have a patent airway in order to have effective ventilation. In many patients this may be as simple as a NPA or OPA if theu are easy to bag, and preventilation/preoxygenation is ideal before advanced airway manipulation. There are also situations in which we will not be able to support their breathing until we have an artificial airway first.
 

StCEMT

Forum Deputy Chief
3,052
1,709
113
I don't know that there is any definite answer one way or another. I know the reasoning behind covering both, but I've yet to see anything about it.

I'd still use a NC even if they were a little below 90. You will find as you get further in this field that there are not many absolutes as it seems right now. You wouldn't use a NC at 90 and a NRB at 89. You have to learn how to gauge what is appropriate for your patient at the time. Which ties into what Peak said, there are patients that throwing all the O2 you can at them is harmful. Obviously the very anxious, tachypneic, air hungry patient you will start off much more aggressive with. The COPD patient that is always on O2 who just happens to not have any flowing St the time and is now 87% will probably be just fine with you on a NC. Don't get stuck on a number. They're helpful and add to your overall picture, but you need to use it in conjunction with your physical exam.

Follow your ABC's. Fix airway first. Any test question is literally in that order. Real world sometimes deviates a little, but it is still held to that order in general. If your airway isnt patent and properly maintained, then the rest can easily go to **** in various situations. For the most part, you can do all 3 at once within the span of a few seconds and make a plan from there.
 
Top