Oxygen and psychogenic shock

[Handsome Robb]

This is malpractice and this mind set is part of the reason we get students on here asking these sorts of questions. Before accepting this as a reasonable thing to do find anything about utilizing a drug or device to leverage the "placebo" effect. Find one protocol mentioning it, one EMS medical director advocating it, or a CE course training on it.

I'm not calling you out for this, but rather the practice and acceptance of it. I despise lying to patients, and this is essentially lying.

Not necessarily.

It's pretty common to put ETCO2 on anxiety patients and show them their numbers and give them a goal to aim for after an explanation as to what will happen if they don't slow themselves down.

 

[unleashedfury]

Well, what would you do? We are not going to just give you an answer

+1000000000000

EMT School and paramedic school is based off of algorithms if your going by the NREMT-B standards Skill sheets. Just follow the skill sheet chromatically and you should be fine. They are available on their website for your use.

OTOH use just simple logic that EMT school should have taught you. Scene Safety, U/P, number of patients and Mechanism of injury, or Nature of Illness.

after that its the simplistic stuff. Go ahead and look for immediate life threats. Pt conscious breathing with a pulse. Hey you got an airway and they are breathing with the blood going round and round. Your already halfway there.

If they are not conscious
Are they breathing Yes? how well? if No Breathe For them.
Is the heart beating? if not thump on the chest. and prepare your AED.

Emergency medicine even at the basic standard is all about protocols and algorithms if you know them in your head and can fix the major life threats your already there.

 

[IslandTime]

They weren't necessarily going for a placebo effect. I feel like I mention this too often on here, but I routinely place capnography cannulas on patients who are having a panic attack. I don't attach the oxygen tubing to anything, and I don't tell the patient I'm giving them any oxygen. I show them how low their "yellow CO2 number" is, explain why it's low, and coach them to slow their breathing as they watch it rise to what it should be.

Bingo. We, that's the royal we as I was only observing, were only looking for the CO2 numbers. We didn't say anything about oxygen. The patient, pancreas transplant, kidney transplant, artificial leg, (I wanted to call my Lucky) was quite medically knowledgable. When he commented that his breathing difficulties had eased the paramedic held up the oxygen end and told him to blow into it to see if it helped. (You had to be there, the PT was really a great guy.) his reaction was kind of "uh, how about that." There was no effort to deceive. It was just the mind of somebody that knew that oxygen might help assumed that oxygen was flowing and helping.

 

[Jambi]

Not necessarily.

It's pretty common to put ETCO2 on anxiety patients and show them their numbers and give them a goal to aim for after an explanation as to what will happen if they don't slow themselves down.

It would seem that I misread ETCO2 part and thought oxygen/device used with out o2 hooked up to it. I think my sentiment is correct, but sorely misdirected. I'm going to put my foot in my mouth now. My apologizes to the involved parties involved.

 

[IslandTime]

It would seem that I misread ETCO2 part and thought oxygen/device used with out o2 hooked up to it. I think my sentiment is correct, but sorely misdirected. I'm going to put my foot in my mouth now. My apologizes to the involved parties involved.

.

 

[NomadicMedic]

This whole concept of blindly "appkying oxygen' to patients makes my head hurt.

It's 2013. When is this stuff going to end?

 

[Jambi]

This whole concept of blindly "appkying oxygen' to patients makes my head hurt.

It's 2013. When is this stuff going to end?

The new curriculum addresses this and even mentions spo2 sats < 95 etc. those teaching just need to pay attention to it and stop war storying/in-the-field-we-do students. It would help if the average EMS educator was actually educated and understood education, instruction adult learners, teaching methodology, pedagogy, etc...

My minor is in instructional design and delivery, so did get me started lol. I just do what I can, when I can, and where I can to have what positive influence I can manage within the system I am forced to exist in.

 

[chaz90]

I missed this when I wrote the last reply. THAT is exactly what I needed to know.

What would I do? If he is P, C, & D, I would put him in Trendelenburg's Position, give him a blanket, and give some O2. Since his problem in these scenarios is relatively minor, I would give low-flow O2, but this is the part I was not sure about. The book just says "give oxygen."

OP, just realize there is an enormous disconnect between the treatments from 1985 that EMT classes shove down your throat and what is actually done in the real world. BLS treatment for shock? Trendelenburg's (or as DEMedic is fond of saying, the "King County Fluid Bolus" ) is worthless, putting a blanket on a patient with a finger amputation for anything other than kindness or keeping them warm in a cold environment is ridiculous, and oxygen rounds out the trifecta of unnecessary "interventions."

Real life treatment of this patient means stopping the bleeding, covering it so they can't see it, and taking the finger with you to the hospital. Apply a cool pack over the site to vasoconstrict and reduce swelling, and call for an ALS intercept for pain control.

 

[Aidey]

I missed this when I wrote the last reply. THAT is exactly what I needed to know.

What would I do? If he is P, C, & D, I would put him in Trendelenburg's Position, give him a blanket, and give some O2. Since his problem in these scenarios is relatively minor, I would give low-flow O2, but this is the part I was not sure about. The book just says "give oxygen."

This whole concept of blindly "appkying oxygen' to patients makes my head hurt.

It's 2013. When is this stuff going to end?

Given the above quoted statement, the OP using a book from roughly 1989.

 

[chaz90]

Given the above quoted statement, the OP using a book from roughly 1989.

Hmm, I said 1985. Can we split the difference and go with 1987?

 

[STXmedic]

Hmm, I said 1985. Can we split the difference and go with 1987?

I would hope medicine has advanced a little since I was born :unsure: Time for an update I think...

 

[Handsome Robb]

It would seem that I misread ETCO2 part and thought oxygen/device used with out o2 hooked up to it. I think my sentiment is correct, but sorely misdirected. I'm going to put my foot in my mouth now. My apologizes to the involved parties involved.

Sorry dude didn't mean to jump down your throat!

I do agree with you though. It's along the same lines of giving a saline flush and saying you administered narcotic analgesics.

 

[RedheadErin]

Given the above quoted statement, the OP using a book from roughly 1989.

Nope. American Academy of Orthopedic Surgeons EMERGENCY Care and Transportation of the sick and injured 10th edition, (c) 2013.

It's right here on their website.
http://emt.emszone.com/docs/CH10_AEC_Table.pdf

I understand this is not what you (or maybe anyone) would do in the field, but this is what I have to work with, right now.

 

[chaz90]

I would hope medicine has advanced a little since I was born :unsure: Time for an update I think...

Medicine has advanced. We in EMS just continue to fight against progress. Apparently we take after our fire service brethren with the whole "40 years of tradition unimpeded by progress."

I kid, I kid. Seriously, I think there are some very good medics, educators, and physicians that are trying to bring us into the modern age. I still try to have some sort of optimism about our future.

 

[STXmedic]

I still try to have some sort of optimism about our future.

My optimism is dissipating by the day. The poor providers staggeringly outnumber the good. Then, as mentioned earlier, these spectacular medics are the teachers of our students. It's a cycle with no end in sight.

 

[Jambi]

Medicine has advanced. We in EMS just continue to fight against progress. Apparently we take after our fire service brethren with the whole "40 years of tradition unimpeded by progress."

I kid, I kid. Seriously, I think there are some very good medics, educators, and physicians that are trying to bring us into the modern age. I still try to have some sort of optimism about our future.

Call it an epiphany or moment of clarity, but it occurs to me that (especially reading the link the the assessment and treatment for shock) that much of this is the result of forcing algorithmic approaches into what is increasingly becoming a clinical world where evaluation, critical thinking, critical application, and discretion is needed. Furthermore, in the continued march of increased training and education, more and more is being added while the foundation of students (nothing really) is being kept sparse.

And we've hijacked the thread...

 

[STXmedic]

And we've hijacked the thread...

Meh, the question has been answered several times already Damn soapboxes... :lol:

 

[mycrofft]

Read the text closely for uses and indications for oxygen administration. If you don't call for it, be ready to defend.
The oxygen supplier I rarely work for says give everyone oxygen.

 

[NomadicMedic]

Thread hijack or not, it's important for the OP to see why the majority of educated EMS providers are against the routine administration of oxygen.

Even though we may have compelling arguments against the routine use of oxygen or backboards or cervical collars… The response will always be, "but, that's not what the book says" or "this is the way my instructor said I have to do it". When you're new provider, and you don't know what you don't know, it's hard to argue with that type of logic.

We are certainly not ganging up on you Erin, although it may feel that way. Most of us are just disgusted with the poor state of EMS education.

 

[VFlutter]

My optimism is dissipating by the day. The poor providers staggeringly outnumber the good. Then, as mentioned earlier, these spectacular medics are the teachers of our students. It's a cycle with no end in sight.

There is always room over here on the dark side. We have cookies.