O2 in ACS

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Av8or007

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I am an Advanced medical first responder (basically a Canadian version of an EMT-B). The 2010 guidelines state that you do not give uncomplicated ACS pts o2 unless they are hypoxic (SpO2 <94%) or dyspnea is present.

If I do not normally have access to a pulse ox, when should I give O2 (other than hypoxia or prior to a "procedure" involving the resp tract?

If you have a pulse ox them titrate to >= 94%?
 
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Handsome Robb

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Are they cyanotic? Are they breathing adequately? How's their mentation? How's their work of breathing? Lung sounds? Is the patient complaining about not being able to catch their breath?

Pulse Oxs can be wrong too, its just another tool.
 
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Av8or007

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Thanks

Good points, check em and if there is an issue put the pt on O2.

"Pulse Oxs can be wrong too, its just another tool."

-Treat the patient NOT the monitor!!!
 
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usalsfyre

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NVRob said:
We have a winner!
Click to expand...

Arggghhh, no!!!

The only reason this phrase exist is because of the heap of paramedics who are not educated enough to clinically correlate the information the monitor presents.

If I'm not using the monitor to base treatment decisions of of, why am I lugging 15+ pounds of extra kit around?
 
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fast65

fast65

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usalsfyre said:
Arggghhh, no!!!

The only reason this phrase exist is because of the heap of paramedics are not educated enough to clinically correlate the information the monitor presents.

If I'm not using the monitor to base treatment decisions of of, why am I lugging 15+ pounds of extra kit around?
Click to expand...

I do it because the cool beeping sounds entertain me, there are other reasons?
 
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Handsome Robb

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usalsfyre said:
Arggghhh, no!!!

The only reason this phrase exist is because of the heap of paramedics who are not educated enough to clinically correlate the information the monitor presents.

If I'm not using the monitor to base treatment decisions of of, why am I lugging 15+ pounds of extra kit around?
Click to expand...

Fair enough. I agree.

You always make me feal dumb, geez usals! :p
 
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usalsfyre

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NVRob said:
Fair enough. I agree.

You always make me feal dumb, geez usals! :p
Click to expand...

Not dumb, not dumb at all Rob, you just happened to hit a pet peeve statement of mine.

Lots of the old saws in EMS grew out of when we were a couple of hundred hour techs who didn't really know the science behind things. We've mostly grown out of those days, but the stupid sayings persist.
 
Shishkabob

Shishkabob

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fast65 said:
I do it because the cool beeping sounds entertain me, there are other reasons?
Click to expand...

If you're stumped, you can stare intently at the screen as if trying to read something. Need more time? Print off a 12 and stare even more intently at that, then say something that sounds like a rhythm.
 
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Handsome Robb

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Linuss said:
If you're stumped, you can stare intently at the screen as if trying to read something. Need more time? Print off a 12 and stare even more intently at that, then say something that sounds like a rhythm.
Click to expand...

I like it!
 
Akulahawk

Akulahawk

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usalsfyre said:
Arggghhh, no!!!

The only reason this phrase exist is because of the heap of paramedics who are not educated enough to clinically correlate the information the monitor presents.

If I'm not using the monitor to base treatment decisions of of, why am I lugging 15+ pounds of extra kit around?
Click to expand...
That's the thing... you DON'T base your treatment around what the monitor says. You base your treatment based on the whole clinical picture, not just what's on the monitor. If you based your care solely on the monitor, we could just send out a robot to hook you up to the machine and the machine can just do it's thing... based on the sensors on board...(the monitor)

We'd get fantastic care every time!!!! :blink:
 
JPINFV

JPINFV

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Akulahawk said:
That's the thing... you DON'T base your treatment around what the monitor says. You base your treatment based on the whole clinical picture, not just what's on the monitor. If you based your care solely on the monitor, we could just send out a robot to hook you up to the machine and the machine can just do it's thing... based on the sensors on board...(the monitor)

We'd get fantastic care every time!!!! :blink:
Click to expand...


The problem is that "treat the patient not the monitor" is taken to the opposite extreme half the time where if the monitor doesn't match exactly what is expected, it is ignored.
 
Akulahawk

Akulahawk

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JPINFV said:
The problem is that "treat the patient not the monitor" is taken to the opposite extreme half the time where if the monitor doesn't match exactly what is expected, it is ignored.
Click to expand...
Sadly enough... this is SOOOO true... and when I was an FTO, not what I taught.
 
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Av8or007

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The thing is that you must take both what the monitor tells you AND the clinical picture that you see into account when treating the pt. Never "ignore" a strange or unusual result on the monitor, just correlate it with the clinical picture and make Tx. decisions based off the integrated clinical picture.

"if it is a textbook case, there's nothing normal about it"
[note: this doesn't always apply]

e.g. a pt that presents with symptoms of an MI USUALLY has chest pain and MAY have ekg changes, but it doesn't mean the patient IS/ISN'T having an MI. There's been cases that present with pain in the jaw.

The inverse is also true, and a PT that presents w/ marked ST elevation indicative of a STEMI may not actually have a STEMI, instead they may have another cond. that causes ST elevation. It takes a good care provider/medic to tell the difference.
 
ArcticKat

ArcticKat

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Linuss and USALSFYRE hard at work.

Thanks JPINFV, I can't figure out the metacode for that.
 
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JPINFV

JPINFV

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ArcticKat said:
<iframe width="420" height="315" src="http://www.youtube.com/embed/arCITMfxvEc" frameborder="0" allowfullscreen></iframe>
Click to expand...
[youtube]http://www.youtube.com/watch?v=arCITMfxvEc[/youtube]
 
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shockinainteasy75

shockinainteasy75

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AHA does not say to not give that pt O2, its a suggestion that...hold ur breath....not everyone needs a NRB at 15lpm. It states that a saturation of 95% is adequate but NC at 2 wouldn't hurt. Remember, the goal in ACS is to drcrease the myocardiums oxygen demand, giving it a little more oxygen will in turn lower demand
 
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usalsfyre

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So O2 can clear coronary blockages and decrease MvO2? Neato...:rolleyes:
 
JPINFV

JPINFV

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Ischemia and hypoxia are not the same thing. Related, but not the same.
 
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