Oxygen and psychogenic shock

[Meursault]

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.

Aww... I'm so proud of you!

 

[Bullets]

Guys, if the patient had amputations of fingers, isnt that a distracting injury? And dont we place patients with distracting injuries in C-Spine precaution?

I cant believe you guys missed that over 5 pages of talk....for shame



{runs away}

 

[mycrofft]

Here's a thought. If O2 can be "for reassurance", then it's mental and ought to be in the DSM, right?

 

[AnthonyM83]

On this foum, I know oxygen is a huge issue, but I think it's not as bad as we make it sound. In my opinion, it's mininally harmful in MIs and strokes.

I don't know about minimally harmful in those specific cases.

But yes, this forum seems to be OVERCOMPENSATING and reacts violently to any talk of oxygen administration outside current recommendations, rather than matter of factly explaining the topic or just referring to an information source to educate.

Oh, here btw:
http://www.jems.com/behind-the-mask
http://www.ems1.com/columnists/mike-mcevoy/articles/1308955-Can-oxygen-hurt/


Fact of the matter is, we've given Oxygen to SO many stable (none major trauma / none respiratory / none MI....rather anxiety, broken bone, small laceration, general malaise) patients as a comfort measure who ended up being just fine. Probably not great for them, but if you're healthy I haven't been seeing studies about morbidity/mortality. Let's not blow it out of proportion to the Original Poster. No they should NOT give the finger laceration a cannula and the OP SHOULD be called out on it, but save the Overreactions for the experienced medic claiming O2 isn't bad...not for the green EMT student simply asking for advice on his/her final scenario.

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.

Some schools like mine weren't really good with giving algorithms. I was very confused as to what to actually do when I got on-scene other than ask OPQRST questions...

 

[AnthonyM83]

Guys, if the patient had amputations of fingers, isnt that a distracting injury? And dont we place patients with distracting injuries in C-Spine precaution?

I cant believe you guys missed that over 5 pages of talk....for shame



{runs away}

I'll give you a distracting injury.....

 

[VFlutter]

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 find it a little odd that an EMT textbook is written by a group of Orthopedic Surgeons. No Emergency Physicians or Trauma Surgeons.

The majority of the Contributors/Editors are EMT-Ps. Some have bachelors or other degrees (MPA, MHA) but many do not. There are very little advanced medical degrees listed.

 

[Aidey]

Guys, if the patient had amputations of fingers, isnt that a distracting injury? And dont we place patients with distracting injuries in C-Spine precaution?

I cant believe you guys missed that over 5 pages of talk....for shame



{runs away}

Go to your room before I ban you.

 

[RedheadErin]

Just for curiosity, what is a better book to use?

Thanks to y'all, I am thoroughly disgusted with this book I had issues with it, anyway, like the way it tells you to use oxygen but doesn't give you any suggestions as to how much, contradictions in the text, and general poor organization.

 

[STXmedic]

Your best and most informative books sadly won't have anything to do with EMT or medic.

 

[Pavehawk]

I find it a little odd that an EMT textbook is written by a group of Orthopedic Surgeons. No Emergency Physicians or Trauma Surgeons.

The majority of the Contributors/Editors are EMT-Ps. Some have bachelors or other degrees (MPA, MHA) but many do not. There are very little advanced medical degrees listed.

You have to remember when the EMT program was first envisioned there were no "trauma surgeons" or Emergency Medicine doctors. The ED's tended to be staffed by IM docs (if they were lucky)or in smaller ERs GP's or whomever they could get including residents moonlighting. ( I have transported out of an ER where the opthomologist on duty was very very happy to see us)

Ortho docs were the main trauma providers and seemed like the logical folks to write the text for this new concept called the EMT.

The orange book and the Caroline are still AAOS but the vast majority of contributors are more correctly specialized in emergency work, though many are not formally educated with uber post nominals. The texts are not perfect (few texts are) and are hampered by needing to follow the national standard ciriculum which we all agree needs some more movement towards real science based medicine.

It seems we always come back to the education issue... too bad the powers that be don't see the trend

 

[RedheadErin]

So here's a question:

Say I get out on a call similar to the ones I was asking about. (a real call, not something I have to get through in order to get out of this class) Let's assume the patient cut of 3 fingers with a circular saw. (no c-spine trauma) He is in horrible pain and he knows his career as a concert pianist is ruined. He is tachycardic, and tachypneic, which is not surprising. He is pale, cool, and diaphoretic, and admits to fainting at the sight of blood, of which there is plenty.

So he might faint, but he hasn't yet. He has lost some blood, but not enough to think he could go into shock with from blood loss alone. We are about 30 minutes from a hospital. My partner wants to put him on Oxygen because that is what we learned in class.

Are the odds more in favor of:

a. He does not need O2, and if I give it, it will cause harm
b. He might need O2, and if I withhold it, it will cause harm
c. He does not need O2, but if I give it, nothing will happen


Come to think of it, in most cases, which is the most likely outcome?

 

[VFlutter]

So here's a question:

Say I get out on a call similar to the ones I was asking about. (a real call, not something I have to get through in order to get out of this class) Let's assume the patient cut of 3 fingers with a circular saw. (no c-spine trauma) He is in horrible pain and he knows his career as a concert pianist is ruined. He is tachycardic, and tachypneic, which is not surprising. He is pale, cool, and diaphoretic, and admits to fainting at the sight of blood, of which there is plenty.

So he might faint, but he hasn't yet. He has lost some blood, but not enough to think he could go into shock with from blood loss alone. We are about 30 minutes from a hospital. My partner wants to put him on Oxygen because that is what we learned in class.

Are the odds more in favor of:

a. He does not need O2, and if I give it, it will cause harm
b. He might need O2, and if I withhold it, it will cause harm
c. He does not need O2, but if I give it, nothing will happen

You did not mention the most important vital sign when trying to determine the need for supplemental oxygen.... Oxygen Saturation!. If he is at 98% on room air then there is no reason to give it.

I would say C, pending sp02. If you absolutely have to give oxygen then throw 1-2L on. In reality you are not really increasing FI02 by much and it won't harm anything. The problem is when you start putting people on 6+lpm and they come in with stupid high P02. If I had a dollar for every time I got a patient from EMS or a outside hospital with a P02 of 300+ I would have at least $10...A week. Or something like that.

I do not like the concept but I do understand there are protocols that require you to do certain things like administer oxygen. In all honesty 2L via NC is fine for pretty much any patient, even if they do not need it.

 

[RedheadErin]

Duh! I forgot the PulseOx. :unsure: But that is why I am asking current practicing EMTs on this board, because you guys know and remember stuff like that. My instructor has been out of the field for years, and my friends are just as clueless as I am (in fact, I think I am the valedictorian so far. That doesn't say much for my class, does it?)

 

[NomadicMedic]

No ALS for pain management? Then proceed to step B.

Step B: Put his fingers on ice, dress the wound and drive to the hospital.

The end.

 

[chaz90]

In your scenario, I'd certainly say C. A couple LPM O2 for 30 minutes isn't going to cause any real harm in this minor trauma patient, but it's more a matter of doing something that doesn't need to be done in the first place. I understand where you're coming from, and I wouldn't say it's much different than most other EMT courses.

 

[mycrofft]

Prove O2 IS reassuring. I'd prefer a sincere EMT who isn't busy "looking and hooking" gauges and machines to me.

 

[Tigger]

I don't think I'd be that reassured if an EMT put my oxygen when I had cut my fingers, I'd think I might start freaking out that there was something wrong with my breathing.

Or at least this is what friends tell me when I have posed similar questions in the "name of science."

 

[AnthonyM83]

Also, it can be a risky move to deviate from the standard of care that the rest of the country or textbooks are following. AHA 2010 Guidelines came out sometime in later 2010...you need quite a bit of time to rework a book and get it through publishing. And AHA only really addresses ACS and CVA type situations. PHTLS still said oxygen for major traumas. Whoever takes the first step is likely to screw something up or try to get blamed for something that goes wrong.

Not that it's a good excuse (since science against routine use of oxygen has been mounting for a long time now...)
Yet the standard of care has not been changing much until recently...

 

[Aidey]

I'm not sure 3 fingers being amputated is major trauma in anyone's book, except for the guy who is missing the fingers.

 

[NomadicMedic]