O2 Almost killed my patient.

systemet said:
And mine reflected my general irritation at the amounts of times I see people putting oxygen on perfectly healthy people for no apparent reason other than some other perpetuated institutional superstition.

Maybe you do this, maybe you don't. And if you don't, great. If I came across as arrogant or confrontational, then my apologies, it wasn't my intent.
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Your absolutely right and I am in the same ball park with the irritation at seeing a mask on someone for no reason. I should have put "as indicated" in my original post, so I apologize if I saw you coming from a different direction.

As for 15 lpm for STEMI, I guess it just started in our county recently because last shift we got blown up about having a code STEMI come through the door without a mask on.
 
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Rather than putting a mask on everyone you might want to have the hospital read the current AHA guidelines.
 
Orange County, tis a silly place.
 
I'm a newb but it sounds to me like you should have given him more O2, provided you were the one to give him the oxygen via nasal cannula.

I haven't done the research yet but I've read and have been told that COPD patients won't see any harm from oxygen unless it's on for a significant amount of time at a reasonably high rate. We're talking like 2 hours or more.

Feel free to offer any reputable sources though because I'm curious.
 
93% is a fantastic SpO2% for a COPDer.

Sounds like he needed a treatment, which he got, not his FiO2% increased. :)

Whoever was talking about not being to monitor SpO2%. while yes it's only a number, some people are too thick headed to understand that without a proper pleth wave the number doesn't mean diddly. If I had a nickel for every time fire or a newer EMT partner has wigged out about a "low" SpO2% on a patient with no respiratory distress or outward signs of hypoxia.
 
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Robb said:
93% is a fantastic SpO2% for a COPDer.

Sounds like he needed a treatment, which he got, not his FiO2% increased. :)
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Just a slight interjection, it was 93% when I walked back into the room. I sat with him talking to him because to me a number doesn't mean much. He described SOB and spoke in short bursts while gasping. I watched the saturation fall to a low of 89% in the minute or so I was talking to him.

The RT showed up less than 5 minutes after I requested her and he was fine following the treatment.

The reason I posted this is because I wanted to understand what the nurse's perspective was. I was not concerned about giving 02. Had the patient been on my ambulance I would have increased o2 until he was breathing adequately. But seeing as he was still at the facility, and I had other resources available to me (the RT) I chose that route.
 
Just FYI, increasing the O2 until he is breathing adequately isn't a great plan. Depending on why he is hypoxic more oxygen isn't going to help. If he has pulmonary edema, pneumonia, asthma, COPD, a pulmonary embolism etc you could be giving him 40lpm and he will still have SOB.
 
Never withhold O2 from a patient that needs it. (Note the NEEDS it part.) If the patient has COPD, just closely monitor the respiratory rate and be prepared to assist with a BVM if necessary.

O2 used to be contraindicated with COPD, but it isn't anymore.
 
albertaEMS said:
O2 used to be contraindicated with COPD, but it isn't anymore.
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Long term high flow O2 can be detrimental to COPD patients. Google "hypoxic drive".

In the short term EMS setting I highly doubt you're going to knock out a COPDer's respiratory drive.

With that said, they don't need a higher FiO2, they need bronchodilators.
 
Robb said:
Long term high flow O2 can be detrimental to COPD patients. Google "hypoxic drive".
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I'm fully aware of that fact and what hypoxic drive is. I was referring specifically to a pre-hospital environment. The change was exactly because of your statement: the minimal time EMS has the patient on O2 is highly unlikely to cause apnea.
 
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albertaEMS said:
I'm fully aware of that fact and what hypoxic drive is. I was referring specifically to a pre-hospital environment. The change was exactly because of your statement: the minimal time EMS has the patient on O2 is highly unlikely to cause apnea.
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To play the devil's advocate, even though EMS may not see the apnea it does not mean that you have not caused long term harm to the patient.

But like Vene mentioned it is extremely rare and only present in a small subset of patients that EMS does not commonly see.
 
Chase said:
To play the devil's advocate, even though EMS may not see the apnea it does not mean that you have not caused long term harm to the patient.

But like Vene mentioned it is extremely rare and only present in a small subset of patients that EMS does not commonly see.
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Can you explain? I suppose even mild depression induced by the O2 could worsen the respiratory acidosis...
 
Chase said:
To play the devil's advocate, even though EMS may not see the apnea it does not mean that you have not caused long term harm to the patient.

But like Vene mentioned it is extremely rare and only present in a small subset of patients that EMS does not commonly see.
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Elaborate?
james_woods.jpg
 
albertaEMS said:
Can you explain? I suppose even mild depression induced by the O2 could worsen the respiratory acidosis...
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Wouldn't the extra oxygen militate against buildup of CO2, thereby combating acidosis?

As mentioned above, for time frames used in PEMS, not usually a problem.
 
--Accidental post removed--
 
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BTW, don't laugh, a succinct article n WIKIPEDIA:

http://en.wikipedia.org/wiki/Hypoxic_drive

And I quote:

"Recent studies have proven that COPD patients who have chronically compensated elevated CO2 levels (known as "CO2 Retainers") are not in fact dependent on hypoxic drive to breathe. However, when in respiratory failure and put on high inspired oxygen, the CO2 in their blood may increase via three mechanisms, namely the Haldane Effect, the Ventilation/Perfusion mismatch (where the regional pulmonary hypoxic vasoconstriction is released) and by the removal or reduction of the hypoxic drive itself."

Time element is still a major factor though.
 
THanks Chase.

The quote from Veneficus:

"Have you considered the oxygen you apply today may take time off of a patient's life decades later? That it may reduce the quality of their life faster and increase their medical bills over time? Have you considered the stress involved with the elderly, particularly on a fixed income and immobile, and the negative health influences of trying to pay for and navigate the health system are?

Let me put it into perspective?

lets say a 65 year old male over the course of his life has lost X% of pulmonary function to age and various pathology.

Let's assume that you put them on 15l of NRB and drive them 30 minutes to the hospital. During this time, you observe them calm down.

3 or 4 months later they develop shortness of breath. They return to the hospital where they are now diagnosed with more advanced pulmonary deficency. They are now not able to carry on their daily routine and their quality of life and maybe even their income is reduced. Perhaps their renal function or liver function as well.

Perhaps that person could have gone another 2-3 maybe 5 years without such a decrease if you hadn't overdosed him on oxygen?

Just something to think about... "

I'm still in the dark, but I know it's my own private dark now...:ph34r:
 
I blame the radicals. Always trying to be free...
 
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