NRB Flow Rate

[usafmedic45]

He's getting pretty wrapped around the axle on every thread.

Here's the really funny thing. What you are seeing as me being "wound up" is my being thorough and blunt. My blood isn't boiling over anything on this forum. In fact, most of it just amuses the hell out of me. I'm actually to the point in my career where a guy with a self-inflicted stab wound to the neck (the last case I handled at work) that required me to do a surgical airway and then to help the doc get the bleeding under control bothered me only because it delayed my going home by almost an hour.

since we have learned a low flow NRB is borderline criminal, what are the 'approved' methods of treating hyperventilation, in the absence of other, more significant issues?

Treat the underlying problem (i.e., panic attack) even if it requires sedating the patient. That, however, is a step that should not be taken in the field under most circumstances.

If you consider someone not being all warm and fuzzy when trying to explain something as vitriole, you need to lighten the heck up more than I do. LOL

Sure you do, for the money of course. Why bill for a standard bed when you could bill for an ICU stay.

Of course. I was just trying not to turn this into one of those debates.

The wallet biopsy also seems to be a concern for some in EMS on this forum and is used to decide what level of care the patient deserves or if they even deserve care.

Even as the reigning misanthrope on this forum, I don't think I would go so far as to say someone doesn't deserve lifesaving care just because they can't afford it. Now, I sure as heck don't think we owe them any more than that but you'd have to be a pretty cold SOB to abandon your duty to care for someone just because they can't pay.

You also have to remember a person who is breathing fast may not be hyperventilating at all and their CO2 might be rising. This is true for infants, peds and patients with chronic lung diseases as well as metabolic disorders.

Excellent point: tachypnea (faster than normal respirations) and hyperventilation (increased minute ventilation) are not the same thing. Technically you don't even have to have the former to have the latter. Probably the best example of why fast respirations does not equal hyperventilation is the severe asthmatic exacerbation. To famously quote a post I made on another forum:

That's breathing about as much as a dog humping your leg counts as sex....it's going through the motions but it doesn't do a whole hell of a lot for you". The patient was trying like hell but had such severe bronchospasm (and probably mucus plugging) that he was moving next to no air and was crashing.

Source: http://forums.studentdoctor.net/showthread.php?p=5499105&highlight=dog+humping+your+leg#post5499105

 

[Phlipper]

ABG means Arterial Blood Gas, not blood glucose. You can not actually confirm a true hyperventilation without knowing a PaCO2. (arterial measurement of CO2). Even an ETCO2 might not be accurate depending on the mismatching and gradient of the arterial to End Tidal measurements.

I would not advise using a paper bag but that might still be in your protocols.

I know what ABG is, I'm a basic and can't do them, and IIRC our medics can't either in the field. Some of us aren't reading the posts.

I'll try one more time before giving up : What would YOU, as a medic, expect your Basic grunt to do for a hyperventilating pt if you've been able to rule out anything worse than anxiety?

And as I mentioned already, the answer may be "Nothing, get them to the hospital asap." and that's cool too. But inquiring minds want to know.

 

[usalsfyre]

What would YOU, as a medic, expect your Basic grunt to do for a hyperventilating pt if you've been able to rule out anything worse than anxiety?

I think the point being made is that you can't do this. And nothing is a great option sometimes.

 

[Shishkabob]

If it IS 'just' hyperventilation and no possibility of anything else, they'll pass out eventually, and the problem will fix itself. h34r:

 

[Phlipper]

So then the answer is "Don't do anything, just get them to the hospital."

Correct? Someone say "Yes" or "No".

 

[Phlipper]

I think the point being made is that you can't do this. And nothing is a great option sometimes.

I have maintained all along that might what was called for, but I kept getting explanations for things I never asked or made clear are above my paygrade. I just needed a clarification that you guys feel nothing should be done. It was already made clear why, and I validated this info in my Para texts.

Trust me ... there is a reason I ask this. I periodically see things done in the field that contradict what I was taught, but I went to the worst EMT-B program on the East coast so there's plenty I don't know. Then I later read here that this or that treatment should never ever be done that way, or done at all. So I like to clarify before I go back to the station and ask why something was done.

 

[usalsfyre]

So then the answer is "Don't do anything, just get them to the hospital."

Correct? Someone say "Yes" or "No".

Nothing if you think everything is ok, O2 if there is ANY concern they are hypoxic.

 

[Phlipper]

Nothing if you think everything is ok, O2 if there is ANY concern they are hypoxic.

Excellent. Thanks!

 

[JPINFV]

I think the point being made is that you can't do this. And nothing is a great option sometimes.

"The delivery of good medical care is to do as much nothing as possible."

Rule 13.
The House of God.

 

[usalsfyre]

"The delivery of good medical care is to do as much nothing as possible."

Rule 13.
The House of God.

If more people took this to heart, we'd be better off.

 

[JPINFV]

If more people took this to heart, we'd be better off.

The House of God should be required reading for anyone entering the health care field.

 

[usalsfyre]

The House of God should be required reading for anyone entering the health care field.

Just think, in a couple of years you'll be eligible for call room nookie too

And yes, even if the medicine is a little old, the message in that book rings clearer than ever.

 

[usafmedic45]

And as I mentioned already, the answer may be "Nothing, get them to the hospital asap." and that's cool too. But inquiring minds want to know.

BTW, if you think they are having a panic attack and no other clinical signs or symptoms to warrant emergency treatment, going by lights and sirens might be a bad idea. Discuss.

The House of God should be required reading for anyone entering the health care field.

Although it seems like more people are reading "The Spirit Catches You and You Fall Down", especially in the premed crowd.

 

[Sasha]

BTW, if you think they are having a panic attack and no other clinical signs or symptoms to warrant emergency treatment, going by lights and sirens might be a bad idea. Discuss.

Let's give them something else to make them anxious and panicy. Loud sirens and a fast, bumpy ride to the hospital

 

[Veneficus]

Let's give them something else to make them anxious and panicy. Loud sirens and a fast, bumpy ride to the hospital

perhaps the same line of thought as:

"i'll give you something to cry about?"

 

[Journey]

If it IS 'just' hyperventilation and no possibility of anything else, they'll pass out eventually, and the problem will fix itself. h34r:

Define "just hyperventilation".

A patient can be "hyperventilating" from a variety of causes that you can not diagnose in the field. If they pass out does that mean your job is done and your diagnosis of "just hyperventilation" is correct? A patient can also "pass out" from acidosis, hypoxia, hypercapnia and cardiac issues. I don't think your advice is very sound.

 

[Shishkabob]

Reading comprehension.


Does wonderful things, doesn't it?

 

[Journey]

Reading comprehension.


Does wonderful things, doesn't it?

Do you carry any POC testing equipment on your truck Linuss? Have you even seen a patient with Chronic Hyperventilation Syndrome? I seriously hope you didn't take them to be a joke.

This article might give you some idea about hyperventilation.

http://emedicine.medscape.com/article/807277-overview

 

[usafmedic45]

Do you carry any POC testing equipment on your truck Linuss? Have you even seen a patient with Chronic Hyperventilation Syndrome? I seriously hope you didn't take them to be a joke.

This article might give you some idea about hyperventilation.

http://emedicine.medscape.com/article/807277-overview

I wouldn't pick a fight with him too staunchly on this. He's one of the sharper paramedics on this forum.

You know the chronic hyperventilation syndrome is viewed by a lot of docs as simply an indication of poorly treated anxiety disorders in over 70-90 percent of cases (depending on the source you want to rely upon)? They are not a "joke" but it's not a medical condition in the strict sense in the vast majority of cases.

From the link you posted:

"Current thinking suggests that the syndrome might better be termed behavioral breathlessness or psychogenic dyspnea with hyperventilation as a consequence rather than as a cause of the condition. It is also recognized that some patients may be physiologically at risk of developing psychogenic dyspnea."

 

[Journey]

I wouldn't pick a fight with him too staunchly on this. He's one of the sharper paramedics on this forum.

Okay....I guess "on this forum" are the key words here.

You know the chronic hyperventilation syndrome is viewed by a lot of docs as simply an indication of poorly treated anxiety disorders in over 70-90 percent of cases (depending on the source you want to rely upon)? They are not a "joke" but it's not a medical condition in the strict sense in the vast majority of cases.

From the link you posted:

There are many pyschogenic disorders that require hospitalization and medication. Too many patients do get blown off because of the "psych" stigma and sometimes even the EDs are easily influenced by something the paramedics have said. We've already seen what has happened to women, the elderly and diabetics when it comes to heart disease and what some "diagnosed" as anxiety or some pyschogenic pain if it doesn't present as the textbook states.