O2 Usage in the field

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keith10247

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Good Morning everyone. I have a question about using O2 in the field. I recently got my cert and am back to riding in the back of the unit instead of being up front driving. In my EMT class, they stressed O2, O2, O2! Stubbed your toe? 15lpm by NRB. Chest pains? 15lpm by NRB. They said EVERYONE should be put on 15lpm of O2 by NRB. We actually would have failed the state test if we forgot to put O2 on every patient we touched. We didn't get the option to use a NC *unless* the patient wouldn't tollerate a NRB.

My question...is this normal? The past year and a half I have been riding, I have never seen O2 be put on a patient who stubbed his toe or who cut their arm. To me, just getting in to the swing of things, it seems excessive!

Am I missing something?
 
No, you're not missing anything. Your educators and the system as a whole is missing something. Its called the ability to educate. The ciriculum has been so watered down that they try to standardize a methodology of treatment for every patient scenerio. Problem is life doesn't work out that way. Stubbed your toe? No you are not getting oxygen. Having a stroke? Then you will probably get some oxygen, but it will probably be via nasal cannula. Having an MI? Then you too may get a cannula. There are too many variable to make a blanket statement like that. Unfortunately, our educational system fails to identify that.
 
Sorry. Really. Either your state system or educational or maybe both.. sucks. Oxygen is a drug/medication. As such, it should not be taken lightly. True it is one of the safest medications, and is is usually harmless but still the emphasis should be placed on proper treatment.

Is the patient in need or will the drug help the person? In other words is it warranted?

Again, one has to perform under protocols but there is a way to get those changed and I would start working to do so.

Good luck, and thanks for noticing the flaw rather than to be a mindless sheep and just following the lead.


R/r 911
 
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Ridryder911 said:
Sorry. Really. Either your state system or educational or maybe both.. sucks. Oxygen is a drug/medication. As such, it should not be taken lightly. True it is one of the safest medications, and is is usually harmless but still the emphasis should be placed on proper treatment.

Is the patient in need or will the drug help the person? In other words is it warranted?

Again, one has to perform under protocols but there is a way to get those changed and I would start working to do so.

Good luck, and thanks for noticing the flaw rather than to be a mindless sheep and just following the lead.


R/r 911
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I totally agree. While it's not harmful, its not always indicated. Glucose is harmless to most patients too but I don't give it every patient either.

In which state do you practice?
 
I was the same as you! When I got out into my ride times, I wanted to slap a NRB on every patient! Oh you just wanted a ride, and are going to change your mind and refuse transport right outside the mall so you get out? O2 for you!

But nearly everytime I went to grab a mask, I was either told its not necessary or to grab a cannula instead.

When I got to medic and started riding at a different station they only give O2 if the person is having chest pains or appears to be having difficulty breathing.
 
keith10247 said:
Good Morning everyone. I have a question about using O2 in the field. I recently got my cert and am back to riding in the back of the unit instead of being up front driving. In my EMT class, they stressed O2, O2, O2! Stubbed your toe? 15lpm by NRB. Chest pains? 15lpm by NRB. They said EVERYONE should be put on 15lpm of O2 by NRB. We actually would have failed the state test if we forgot to put O2 on every patient we touched. We didn't get the option to use a NC *unless* the patient wouldn't tollerate a NRB.

My question...is this normal? The past year and a half I have been riding, I have never seen O2 be put on a patient who stubbed his toe or who cut their arm. To me, just getting in to the swing of things, it seems excessive!

Am I missing something?
Click to expand...

Here's the deal about the National Registry on testing; especially for basics. They will test to see how you treat the worst case scenario in which case you will be giving 15lpm NRM. In real life, however, that will not necessarily be the case because the majority of your calls will not be the worst case scenario with regards to O2 administration.

Remember, they are not only testing you (as intelligent as you and your crews may be), but also testing the lowest common denominators. Passing any standarized test only means one thing: that you have successfully completed the minimal requirements.

True learning begins with experience. And you cannot teach experience.
 
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Unfortunately the basics of oxygen delivery are not taught. Therefore, without this understanding it is difficult to choose the appropriate delivery device for the patient. Too many rely on cookbook recipes which state 2 L NC = 28% or that a NRBM is a high flow mask (which it is not by true definition). They then are at a lost when they don't get the same results for every patient that have had these devices in use. Thus, instead of teaching the basic principles of how each device works and the limitations, it is often easier to just give a blanket recipe which may or may not be necessary and appropriate for all.
 
VentMedic said:
Unfortunately the basics of oxygen delivery are not taught. Therefore, without this understanding it is difficult to choose the appropriate delivery device for the patient. Too many rely on cookbook recipes which state 2 L NC = 28% or that a NRBM is a high flow mask (which it is not by true definition). They then are at a lost when they don't get the same results for every patient that have had these devices in use. Thus, instead of teaching the basic principles of how each device works and the limitations, it is often easier to just give a blanket recipe which may or may not be necessary and appropriate for all.
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I understand that you are saying, but what do you expect for the EMT-Basic? They spend a class or so on each topic and then move on. The EMT-Basic is like a survey course compared to the EMT-Paramedic.
 
MMiz said:
I understand that you are saying, but what do you expect for the EMT-Basic? They spend a class or so on each topic and then move on. The EMT-Basic is like a survey course compared to the EMT-Paramedic.
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Unfortunately few Paramedics get the basic principles in their class. Very few even understand Minute Ventilation. Few understand hyperventilation, hypoventilation, hypoxic, hypoxic drive and hyperoxygenation. Rarely are the descriptive terms like tachypnea used. Thus, to explain the entrainment and flow principles (Venturi and Bernoulli) would be difficult for some to grasp. FFs usually do the best here believe it or not.
 
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Thanks for the replies. I am glad to know that I did not sleep through something!

I am in the state of VA. I just checked local protocols and it lists the following:

Indications:
-Confirmed or suspected hypocia
-Ischemic chest pain
-Respritory insufficiency
-Confirmed or suspected CO poisoning
-Any cause of decreased tissue oxygenation

Side effects:
Resp: Drying of mucous membranes

There is a protocol consideration that lists the following:

-Minor illnesses or injuries, if required:
Dose: Adult and Ped. - Low concentration via administration by NC at 1-6lpm

-Severe illnesses or injuries:
Dose: Adult and ped. - 100% or high flow administration via NRB (>10lpm or other high-flow O2 via delivery device.
 
Oh,
One other question: In my EMT cirriculum, they taught a lot about the FROPVD (Flow restricted oxygen powered ventillation device (I believe)).

We actually had a question about this device on the written test.

I have never seen one used! I have seen pictures in the book..just not in real life. Is this device actually used in the field?
 
Strictly from an administrative point of view, slapping a NRB at 15lpm is going to run through O2 a lot faster.
 
keith10247 said:
Oh,
One other question: In my EMT cirriculum, they taught a lot about the FROPVD (Flow restricted oxygen powered ventillation device (I believe)).
Click to expand...

These demand valve devices have their problems which center around the expertise of the user.

They are taking a back seat to ATVs to become compliant with suggestions from the AHA guidelines. The CareVent EMT is very simplistic but provides simple ventilation with preset rates and volumes. However, as with all powered ventilation devices, one must continue to assess the patient for breath sounds and chest rise.
 
Flight-LP said:
Having an MI? Then you too may get a cannula.
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Just wondering why an MI would possibly get a cannula. I can understand cut or stubbed toe.. but O2, isn't that, at a BLS level like really important. I mean our treatment options are limited to ASA, Nitro, Entonox and O2 mostly?
I've been taught that 10 Lpm via NRB is important with an MI. So why is this? Just curious.
 
Ok, my last post doesn't really make sense.. I was kinda busy while typing it up so I'll re do it.

Flight-LP said:
Having an MI? Then you too may get a cannula.
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Why would you give an MI patient a cannula with 4 Lpm. I can understand not giving a cut, or stubbed toe O2, I mean why would you? But someone having an MI, wouldn't that warrant 10 -15 Lpm via NRB. I was taugh that if they are satting at close to 100 on the SpO2 than still give 10 - 15 Lpm. (Treat the p/t not the machine"). Anyways.. whats your reasoning to cannula? Thanks!
 
traumateam1 said:
Ok, my last post doesn't really make sense.. I was kinda busy while typing it up so I'll re do it.


Why would you give an MI patient a cannula with 4 Lpm. I can understand not giving a cut, or stubbed toe O2, I mean why would you? But someone having an MI, wouldn't that warrant 10 -15 Lpm via NRB. I was taugh that if they are satting at close to 100 on the SpO2 than still give 10 - 15 Lpm. (Treat the p/t not the machine"). Anyways.. whats your reasoning to cannula? Thanks!
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Oh no.. not again.


From an ALS perspective - if the patient is NOT obviously hypoxic - espicially if their pulse oximitry reading is good... then there is no reason they need high-flow O2.
 
Jon said:
Oh no.. not again.


From an ALS perspective - if the patient is NOT obviously hypoxic - espicially if their pulse oximitry reading is good... then there is no reason they need high-flow O2.
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That would depend on the clinical appearance of the patient. If the patient is working hard to maintain their SpO2, then more O2 may be required. It the cardiac output and myocardium are starting to fail, who knows what the patient will require. 100% O2 by ventilator and IABP could be in their future very easily.

Some patients will do very well on 2 - 4 liter depending on their WOB. The AHA is not opposed and many cardiologists still may want supplemental O2 for first 6 hours during an MI or with the initial clinical indication of an MI. Depending on how much O2 is required will later determine the free radicals. More pharmacological and surgical intervention may be required to improve the MVO2 and eventually reduce the requirement for supplement O2. Regaining coronary blood flow and perfusion will be what determine the outcome. O2 will be supportive care to maintain a good SpO2 and decrease work of breathing.

http://www.emedicine.com/med/byname/myocardial-ischemia.htm

Again, it is about education for the proper use of the medication (O2) at hand and not memorization from an index card. No two patients may present the same. There are other diseases that mimic an MI so again the recipe may not always apply to everyone.
 
traumateam1 said:
I wasn't talking ALS though, I was talking BLS.
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Point.

I'm BLS too... HOWEVER, around here, BLS is trained to follow "if A, do B" protocols... so they give high flow O2 to every patient.

If the patient isn't going to really need the additional O2, and are just in need of a LITTLE O2... no sense covering their face with a big mask, and raising their anxiety and stress, as well as making it harder to understand them.
 
Thanks Vent,
You answered my question pretty well. If the patient is satting well on R/A or NC and not working hard for O2 than no need for NRB, however if they aren't satting well with R/A or NC than 10-15 Lpm via NRB is good.
 
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