Oxygen in advanced care

How often do you routinely use O2?

  • All the time, most of my patients get it

    Votes: 4 12.1%

  • Sometimes, even if they don't look like they need it

    Votes: 15 45.5%

  • Only in patients that have clear signs of hypoxia

    Votes: 13 39.4%

  • What's oxygen?

    Votes: 1 3.0%
  • Total voters
    33
U

usalsfyre

You have my stapler
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I am fortunate to work in a system that only specifies O2 administration in cases of hypoxia which can be reversed by O2 administration (chiefly, hypoxic hypoxia). The result of this is that I only put around 10% (maybe less) of my patients on supplemental O2.

I still however, see my colleagues placing nearly everyone on at least a minimum of 2L by NC, and often a NRB when there is no complaint of SOB and no clinical signs of reversible hypoxia. The reasoning behind this is "we've always done it this way".

So I submit to the forum. How many of you routinely use oxygen on your patients outside of the setting of hypoxic hypoxia?
 
The good old ambo trick of more is better does not apply here oxygen is a drug and hyperoxia can lead to free radical/reperfusion injury, cereberal and arteriole hypoxaemia due to vasoconstriction and other funky things

Not everybody needs fifteen litres of oxygen crammed down thier gob and Brown praises Jeebus that somebody on your side of the Pacific seems to get that!
 
If I think hypoxia might play a role or help, I'll start the patient on a nasal cannula, however rarely a non-rebreather (basically, unless there's some sort of respiratory distress or worse).
 
I'm in the same camp as JPINFV. If there's a condition that supplemental O2 can help... I'll provide that drug. Most of my patients never got additional O2.
 
MrBrown said:
Not everybody needs fifteen litres of oxygen crammed down thier gob and Brown praises Jeebus that somebody on your side of the Pacific seems to get that!
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I get it!!!! But no one in my county will listen to me! I am getting tired of trying to change peoples minds.

Here is an idea I have been batting around with myself. If you try to keep people at a mid 90s sat, you aren't really hyper-oxygenating them, are you? Correct me if I'm wrong.

I unfortunately had to vote that most of my patients get it even if they don't look like they need it. I only do that because that is what my protocols say, that is what my SEI demands and the hospital will yell at us if we don't bring most everyone in on high con O2. (Ok, some of the staff will. A few agree with me.)
 
I try to be judicious in my use of O2, and I tend not to use a lot of it.

I can probably count on both hands how many times I've used a NRB in the last year. That excludes using a mask to hold a neb. Unless there are signs of severe hypoxia I stick to a cannula if I'm giving oxygen. I really like the ETCO2 cannulas, and use them on a lot of pts with a respiratory complaint. There are also times I will use the CO2 cannula without hooking it up to O2, like in some hyperventilating pts.
 
Of course, hypoxic patients.

Anxious patients who think they are hypoxic and benefit from the placebo effect too.
 
We don't even carry oxygen anymore.

My partner just blows in the tubing.

Why is this in the ALS section?

When it benefits the patient, maybe once a shift.
 
MasterIntubator said:
Oxygen is over-rated.
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Exactly the point I've reached.

The reason this is in the advanced forum is I would prefer to get opinons from folks who should be able to corectly interpret if a pt needs O2. This is not something I'm convinced the current EMT-B curriculm is preparing folks for.
 
I don't have any idea what they teach in EMT classes nowadays but when I took my class, the entirety of the program was assessment based, treat the patient not the complaint. Today I believe providers just need to feel and look busy, they assume when a patient dials 911 they must need some form of intervention. If all they need is a ride that's s what they get, if after assessment I feel they need oxygen then they will receive it. I treat oxygen like any other medication you get it when its warranted.
 
CAOX3 said:
I don't have any idea what they teach in EMT classes nowadays but when I took my class, the entirety of the program was assessment based, treat the patient not the complaint. Today I believe providers just need to feel and look busy, they assume when a patient dials 911 they must need some form of intervention. If all they need is a ride that's s what they get, if after assessment I feel they need oxygen then they will receive it. I treat oxygen like any other medication you get it when its warranted.
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What they are teaching around here is that stinking everyone gets O2. I was taught in my basic class that I could give everyone 15 liters by NRB. No questions asked. I totally disagree with that, and I don't give every pt a mask, but I am "forced" to give 90% of my pts O2.

And in reference to your assessment bases pt care comment, that is what is so funny. Over and over and over again during my basic class and in all the ones I have helped teach the underlying theme is "treat the patient, not the machine. Treat the pt, not the scene. Treat the pt......etc." Yet in my basic class, we were taught that since we are with the pts for a short time (no more than 90-120 minutes) that hi flow O2 won't hurt. Again, I disagree, but like I said earlier, it is like beating my head against a wall to get people to even entertain the thought that I could be right. And I dunno why.
 
Only patients who might benefit from a little extra oxygen, such as decreased SpO2 or active MIs.


Vast majority of my patients don't get oxygen from me, and of those that do, 99% get a NC. I hardly ever use a mask.
 
Oxygen is a drug, I don't enable junkies. Plus, im too busy texting pictures of the patient to my friends and shooting up narcs from the drug box to be worried about all that perfusion mumbo jumbo.


J/k Actually, I administer oxygen on a case by case basis. If I feel the patient needs it (example: Chest pain with shortness of breath), I'll throw it on. Sometimes I will throw them on a cannula if I don't feel oxygen is truly warranted but still want to give them supplemental 02.
 
What the hell is wrong with you guys. Once I get the patient in the back, I duct tape around the doors and open up all the flow meter valves to 25lpm. Call it a mobile oxygen tent. While we're en route to the ER, my partner chain smokes up front while driving. That shouldn't be a problem, should it?
 
As long as you don't attempt to defibrillate, you should be fine.
 
cant remember the last time i used o2 on a patient,was a few months ago id say.(just because your taking a trip in my ambulance doesnt mean your gettin o2.... come on it doesnt grow on tree's??? hahaha ) ive seen alot of crews though stick on 15lpm to the smallest of things like a sore toe or finger.

my clinical practice guidlines state spo2 below 97%(92% in copd patients) resp distress or resp arrest and an ami

it says in a few other guidlines in the book consider o2, its at our discresion if or when needed
 
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Linuss said:
Only patients who might benefit from a little extra oxygen, such as decreased SpO2 or active MIs.
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Intending absolutely no offense or smartass comment.

Logically, if the blood goes through the pulmonary circuit to the left ventrical, said ventrical contracts sending blood into the aorta, which during diastole back fills into the coronary arteries, how does the oxygenated blood get from the proximal end of the aertery through the thrombus/embolis, and to the distal part of the artery and capilay beds?

Unless there is some other disorder, there should be no problem with heme saturation until methylation or coboxy haemaglobin from pump failure, or an increase in PH.

Correcting even the pH will not push oxygen past a clot.
 
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