Oxygen, anyone?

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Juuuuuust in case anyone was still laboring under the misapprehension that O2 is some sort of benign panacea:
Effects of oxygen inhalation on cardiac output, coronary blood flow and oxygen delivery in healthy individuals, assessed with MRI. European Journal of Emergency Medicine 2011, 18:25–30

Very small study and done in healthy volunteers, so we need to take care, but the long and the short of this one is that O2 decreased left ventricular perfusion, decreased cardiac output and thus decreased systemic and cardiac oxygenation. Just add it to the pile!

When I have my STEMI, unless I am shocked or actually hypoxic, I will take that O2 tubing and wrap around your neck very tightly if you try to give me O2.
 
Interesting indeed. It continues to validate what has been known since the late 1950s.
 
What I would like to know i just how long it is going to take the average MPD to actually do something progressive and attempt the un-training of all us monkeys.

Unfortunately I am like one of the only ones at my service that thinks like this. The rest make all the usual claims, "Oxygen can't hurt you" "Go big or go home, right?" "Oxygen is good for you, so more is better." But they (of course) can't back it up. I always bring all these articles and research reports in for people to read and I am treated like some kind of heretic. Thank God I just work for the county and not the Roman Catholic Church of Centuries ago, I'd have been burned at the stake by now. I ride a fine line between doing what research has shown is good for my pt and blatantly breaching protocol. (Which idiotically states "apply high concentration/high flow oxygen" on every single page.) I use more NCs than the rest of the crew put together and I also bring in more people without oxygen (What? Stone him to death!) than anyone else. I am not withholding it if they need it, but does a pt with kidney stones and a room air sat of 99% really need any supplemental 02?
 
Its made its way to PA protocols already. No more blanket treatment with high-flow O2.
 
Screw that, every pt I touch is getting high flow o2 with a NRB and a stay on a backboard via rapid takedown.

People need to understand that we are not doctors, we work on the streets and we intubate upside down in ditches in the middle of hail storms.

This is the streets, no time for egg head studies. :ph34r:

No this is really intersting, thanks for posting. I need to share with everyone in EMS I know who just refuese to believe 02 is not the best thing ever for everyone in as large ammounts as you can manage.
 
On a related note the airline I work for just changed our onboard protocols regarding O2. We no longer administer O2 unless told to do so by ground medical personnel via radio or a qualified medical provider onboard. Previously it was SOP to put all ill passengers on O2. All O2 on the aircraft however is low flow however (4 liters max).
 
I read this then got sent to a breathing difficulty. First responder paramedic (that I know cuz they work for us) has the patient on NRB @15 lpm and is quite proud he is now at 100% sats. Room air initially was 96% with no distress. Why did they use a NRB? Well cause it's a breathing difficulty call.

I think my eye roll and sarcastic response got the point across. Well that and taking it off of the patient in front of everybody.
 
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Oxygen is not clinically beneficial in all patients and should not be randomly administered.

Use the simpliest device and lowest flow rate to achieve a SPO2 of >95% if the patient appears hypoxic or hypoxaemic.

Or so Brown thinks
 
MrBrown said:
Oxygen is not clinically beneficial in all patients and should not be randomly administered.

Use the simpliest device and lowest flow rate to achieve a SPO2 of >95% if the patient appears hypoxic or hypoxaemic.

Or so Brown thinks
Click to expand...

My thoughts as well. My soon to start paramedic school partner looked at me funny till I explained this all to him. Lightbulb. Now he understands as well and sees I wasn't trying to be a jerk. Well this time at least.
 
My protocols state that SpO2 will be maintained at >95% at all times and that O2 of at least 2 LPM via NC is mandatory for chest pains. For all non-chest pain patients, if my patient is maintaining sats above 95% without oxygen with no signs of respiratory distress, then oxygen isn't indicated as far as I'm concerned. And with chest pains, I err on the lowest necessary dose of oxygen to maintain SpO2 and titrate up as necessary. Just like any drug, it has to be indicated and/or approved/required by protocol for my to use it, as far as I'm concerned.
 
I kinda learned the same thing in an Advanced Cornary Systems class back in 2004
 
Bieber said:
My protocols state that SpO2 will be maintained at >95% at all times and that O2 of at least 2 LPM via NC is mandatory for chest pains. For all non-chest pain patients, if my patient is maintaining sats above 95% without oxygen with no signs of respiratory distress, then oxygen isn't indicated as far as I'm concerned. And with chest pains, I err on the lowest necessary dose of oxygen to maintain SpO2 and titrate up as necessary. Just like any drug, it has to be indicated and/or approved/required by protocol for my to use it, as far as I'm concerned.
Click to expand...

I completely agree with what you typed. I practice the same thing!
 
SeeNoMore said:
Screw that, every pt I touch is getting high flow o2 with a NRB and a stay on a backboard via rapid takedown.

People need to understand that we are not doctors, we work on the streets and we intubate upside down in ditches in the middle of hail storms.

This is the streets, no time for egg head studies. :ph34r:
Click to expand...

L-O-to the- L!!

tumblr_lhtd3w95eI1qeplj6o1_400.gif
 
I took a little bit of time to read the article cited. It's interesting, and thought-provoking.

However it remains a small study (n = 16) of healthy volunteers. Their primary finding is that although patients receiving supplemental O2 have a greater arterial oxygen content, they exhibit slower heart rates, resulting in a lower cardiac output, and lower coronary and systemic oxygen delivery.

They speculate, but don't show, that this reduction in O2 delivery results in a decrease in oxygen extraction. They report no clinical symptoms in their healthy volunteers, as one would expect. They suggest that reductions in coronary oxygen delivery might be dangerous for "healthy patients" with baseline coronary artery disease.

I absolutely agree that all therapies should be administered in a responsible manner, and should be directed by the patient's clinical presentation. But I want to point out that this study does not show that oxygen administration is actually dangerous for anyone.
 
Very insightful thread guys and gals. Good info in here.

I cant speak for every medic program but all ive heard over the last few semesters is that "everyone gets O2".

Ill be raising my hand a few times during our next lecture.
 
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