New EMT, don't understand a couple of calls.

[Shishkabob]

How are you as an EMT going to rule out other causes cardiac in origin, or elsewhere? Negative signs does not mean negative presence.


Heck, we still can't rule everything out as a medic.




Now, that doesn't mean I won't treat it as such, if it's my DDX.

 

[got_shoes]

it depends on your protocols

Why would you want to with hold o2 in that situation? SpO2 reading may be a little off in that case, along with person's suffering from hyperventilation may have spasm's in the extremities, in extreme cases. the hyperventilation may be a issue of other cardio-respiratory disease. further more if you can convince your Pt. that the o2 will help with their hyperventilation, their respiratory rate may decrease.

 

[jjesusfreak01]

Why would you want to with hold o2 in that situation? SpO2 reading may be a little off in that case, along with person's suffering from hyperventilation may have spasm's in the extremities, in extreme cases. the hyperventilation may be a issue of other cardio-respiratory disease. further more if you can convince your Pt. that the o2 will help with their hyperventilation, their respiratory rate may decrease.

Right, it is certainly true that talking down the patient while on oxygen will both fix the hyperventilation and won't put the patient at additional risk from lack of oxygen, but if the history (especially events leading to problem) as well as spO2 should give you a good idea if it is hyperventilation. Obviously, in this case you would want to start the oxygen immediately if there was any question, but are there any conditions other than hemoglobin binders (CO) that will give an spO2 reading of 100% and present with the same breathing symptoms? Seeing as most cardiac and pulmonary problems reduce blood oxygen content and most people are around 98% or less on room air, 100% would seem to be a good indication of hyperventilation.

This is really just a thought experiment of course, because once I get oxygen on the patient I will expect to see near or at 100% on the pulseox anyways, so it will be useless as a diagnostic tool for hyperventilation, except that spO2 of less than 100% on a NRB will pretty much indicate that it is not hyperventilation.

 

[MonkeySquasher]

but are there any conditions other than hemoglobin binders (CO) that will give an spO2 reading of 100% and present with the same breathing symptoms?

Yes and no. CO will bind with the hemoglobin and result in a falsely high SPO2 reading, but the patient will present as general illness, bright red cheeks, and possibly altered mental. There may or may not be breathing problems.

Seeing as most cardiac and pulmonary problems reduce blood oxygen content and most people are around 98% or less on room air, 100% would seem to be a good indication of hyperventilation.

This is really just a thought experiment of course, because once I get oxygen on the patient I will expect to see near or at 100% on the pulseox anyways, so it will be useless as a diagnostic tool for hyperventilation, except that spO2 of less than 100% on a NRB will pretty much indicate that it is not hyperventilation.

Negative. People can have a "normal" SPO2 of anywhere from high 80s (chronic COPD) to 100%. I normally have a 99-100% reading, but only normally breathe 8-10/min.

Conversely, it's quite possible to have a person hyperventilating at 30/min with an SPO2 of 95%, or higher/lower. Hyperventilation is a representation of respiratory rate. SPO2 is a representation of gas exchange in the lungs/blood. Respiratory rate is no indicator of gas exchange.

 

[Shishkabob]

Really there is no point in withholding O2 from someone that is hyperventilating from an anxiety disorder. Give 'em O2, and one of 2 things will happen:

They'll calm down, or they'll pass out. Either way they'll be breathing back to normal in no time.



THat IS, if it's just anxiety and not some other underlying cause such as cardiac in origin.

 

[MonkeySquasher]

They'll calm down, or they'll pass out. Either way they'll be breathing back to normal in no time.

haha. Eventually, the body hits the Reset button and all is well. B)


...Or you suddenly get a lot more busy.

 

[jjesusfreak01]

Negative. People can have a "normal" SPO2 of anywhere from high 80s (chronic COPD) to 100%. I normally have a 99-100% reading, but only normally breathe 8-10/min.

As opposed to the other type of COPD...

Thanks for all the information. I think these types of discussions help me get a much better grasp on concepts and are really helpful. I'll bet the originator of this thread would agree.

 

[Aidey]

That IS, if it's just anxiety and not some other underlying cause such as cardiac in origin.

The issue I have with putting O2 on anxiety patients is that it can reinforce the patient's mindset that it is a problem that can just be "fixed" with medication, or the idea that it is some other problem and not anxiety.

Obviously patients with anxiety can have other things going on, but I think it is important for patients who have anxiety to understand their anxiety and what it feels like so they know what is going on. Kind of like asthma patients and asthma, or seizure patients and auras. Not that you should let patients suffer or anything like that, its just that for the patient understanding they are having an anxiety attack can help prevent the process from progressing. Continually short circuiting that process can negatively affect the patient.

There could also be hematologic causes, namely most of the anemias.

 

[mcdonl]

According to my training and state protocols....

If a patient is having difficulty or SOB I am to give O2... I am a basic, I do not diagnose. I was taught never under any circumstance should I withold O2.

 

[got_shoes]

A provider's job is to know the human body and its functions in terms of normality (homeostasis). The four cornerstones of diagnostic medicine, each essential for understanding homeostasis, are: anatomy (the structure of the human body), physiology (how the body works), pathology (what can go wrong with the anatomy and physiology) and psychology (thought and behavior). Once the provider knows what is normal and can measure the patient's current condition against those norms, she or he can then determine the patient's particular departure from homeostasis and the degree of departure. This is called the diagnosis. Once a diagnosis has been reached, the provider is able to propose a management plan, which will include treatment as well as plans for follow-up. From this point on, in addition to treating the patient's condition, the provider educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as providing advice for maintaining health. source: wikipedia

Based upon those criteria, how would you know when medical Pt's need intervention at a hospital, and which hospital would be best for you Pt.?

 

[Shishkabob]

The issue I have with putting O2 on anxiety patients is that it can reinforce the patient's mindset that it is a problem that can just be "fixed" with medication, or the idea that it is some other problem and not anxiety.

Obviously patients with anxiety can have other things going on, but I think it is important for patients who have anxiety to understand their anxiety and what it feels like so they know what is going on.

True, true. I don't advocate doing a NRB for these types of patients but I still support SOME oxygen. as it does make them think you're doing something and that in and of itself calms them down.. At most it would be a simple face mask.

I had a patient back in February, 14yo having 'chest pain' after being arrested by PD, so we were called out. Did my full assessment, no cardiac history, history of drugs, CP "11/10" started right when he was arrested, hyperventilatory ratre of 30's carpalpedal spasms, High SpO2, low EtCO2.


I gave him a NC at 4lpm and coached him down making him look at the EtCO2 readings, trying to get them back above 35. We still ended up transporting because the cop didn't feel safe with it.

 

[Trayos]

True, true. I don't advocate doing a NRB for these types of patients but I still support SOME oxygen. as it does make them think you're doing something and that in and of itself calms them down.. At most it would be a simple face mask.

Like the placebo effect?

 

[irish_handgrenade]

SPO2 is a representation of gas exchange in the lungs/blood. Respiratory rate is no indicator of gas exchange.

Actually SPO2 is a representation or the percentage of available hemoglobin is bonded with O2 or CO. Endtidal capnography is a representation of gas exchange within the lungs/blood...

 

[jjesusfreak01]

Actually SPO2 is a representation or the percentage of available hemoglobin is bonded with O2 or CO. Endtidal capnography is a representation of gas exchange within the lungs/blood...

What effect will CO poisoning have on SPO2 readings?

 

[TransportJockey]

What effect will CO poisoning have on SPO2 readings?

It can make SPO2 read at 100%. CO has a much higher affinity to hemoglobin than O2

 

[jjesusfreak01]

It can make SPO2 read at 100%. CO has a much higher affinity to hemoglobin than O2

Sorry, I should have checked my post...I meant ETCO2 readings.

 

[irish_handgrenade]

end tidal CO2 measures the exchange of gasses, if you have CO poisoning then your body won't be making much CO2, so your end tidal will be off, but your SPO2 will show at 100% or whatever. Anyway you took my post out of context, I was correcting an error in what that other guy said " SPO2 is a representation of the exchange of gasses in the blood/lungs" and he was wrong.

 

[MonkeySquasher]

Actually SPO2 is a representation or the percentage of available hemoglobin is bonded with O2 or CO. Endtidal capnography is a representation of gas exchange within the lungs/blood...

Ah, you are correct. Well played.

 

[Emevas]

Recently watched a Little League baseball game when a batter was hit by a fastball on the left ear side of helmet.

Batter immediately dropped... he remained conscious.

Players coach waved off people on field as he approached the batter and attended to player.

As an EMT, what would you do?

I'd go in, assess his level of conciousness, do some neuro tests to check for focal deficits.

ask him if he's having a hard time breathing, check the pulse, check his breathing (could be signs of a head injury (aka cushing triad)), like say he's a kid, and hes braddin along at a rate of 40, breathing at 10 a min, and his pressure is 190/110, not normal vits for a kid...

however, being new to this site, i live in canada, and work as an EMT in a metro service, many of our patients are fine... actually a LOT of our patients are fine, and just request to go to the hospital (for their sore knee from the fall they had 8 days ago :glare.

the fact that it was a baseball is a pretty low mechanism of injury, hitting the hard helmet may have just gave him a slight concussion, probably stunning him as he's never felt that before.

but if it was serious, rapid transport, IV, o2, monitor, basic EMT skills that should be done on every unwell patient.

yup, BLS seems like an intimidating job, but its the easiest thing you can imagine.

LOC - ABC's - Bleeding (stop bleeding!) - other injuries or signs of illness?(aka assessment) - treat based on your protocols.

 

[Akulahawk]

Recently watched a Little League baseball game when a batter was hit by a fastball on the left ear side of helmet.

Batter immediately dropped... he remained conscious.

Players coach waved off people on field as he approached the batter and attended to player.

As an EMT, what would you do?

My comments to you, Emevas, inline, in red...

I'd go in, assess his level of consciousness, do some neuro tests to check for focal deficits.
Under what authority are you making contact with the batter? The coach isn't requesting your assistance yet. What neuro tests do you do, when, and why?
ask him if he's having a hard time breathing, check the pulse, check his breathing (could be signs of a head injury (aka cushing triad)), like say he's a kid, and hes braddin along at a rate of 40, breathing at 10 a min, and his pressure is 190/110, not normal vits for a kid...
I doubt you'd see that severe of a head injury in a Little League player absent some congenital defect.
however, being new to this site, i live in canada, and work as an EMT in a metro service, many of our patients are fine... actually a LOT of our patients are fine, and just request to go to the hospital (for their sore knee from the fall they had 8 days ago :glare.

the fact that it was a baseball is a pretty low mechanism of injury, hitting the hard helmet may have just gave him a slight concussion, probably stunning him as he's never felt that before.
A baseball, pitched at someone's head, at 90+ MPH will do more than a minor concussion if the impact is in the right area. How confident are you in evaluating concussions? The fact that this is Little League means that chances are the kid may not even have a concussion, but is just surprised that he got hit in the head. Of course, some of the older Little Leaguers can develop some serious fastball speeds.
but if it was serious, rapid transport, IV, o2, monitor, basic EMT skills that should be done on every unwell patient.

yup, BLS seems like an intimidating job, but its the easiest thing you can imagine.

LOC - ABC's - Bleeding (stop bleeding!) - other injuries or signs of illness?(aka assessment) - treat based on your protocols.

I have quite a bit of education in this area. Much of it I'm unable to use while on the job as a prehospital provider, due to scope of practice issues.