Oxygen Question

[leoemt]

So a couple of weeks ago I was with my FTO and we responded to an unwitnessed fall at a rehab center. The patient was a 20's female who stated that she woke up on the floor and did not know how she got there. Her only complaint was right shoulder pain and I did notice deformity to right clavical upon palpation.

We did c-spine precautions due to it being unwitnessed and the MOI and transported her priority to the hospital.

Patient was alert and oriented x4 and was answering questions appropriately and in complete sentences. She did complain of dizziness and being tired though, no head pain or trauma though. All vital signs were normal for her age. We do not do pulse oximetry in the field in this county so unknown Sat's. At the hospital she was 100% on 2lpm.

In the back of the ambulance my FTO made me place the patient on oxygen. Patient had no signs or symptoms requiring a clinical need for oxygen in my opinion. She was not Hypoxic or Cyanotic and was breathing at about 14 times /min. Respirations were normal rate, rhythm and depth.Lung sounds clear all fields. I placed the patient on 2lpm via NC to appease my FTO.

My FTO never told me a reason for him wanting her on O2 other than it was a Syncopal Episode. So that leads me to my question, was there a clinical need for this patient to be on Oxygen that I am missing? I am uncomfortable performing any intervention when I can't justify it to a doctor or nurse. Had the ER asked me why she was on O2 I wouldn't have had an answer to give them.

My FTO was upset that I didn't put her on O2 earlier and I got marked down for it, though I don't think she needed it.

 

[Medic Tim]

O2 and other things mentioned were not needed/indicated

 

[leoemt]

O2 and other things mentioned were not needed/indicated

I agree. I would have done the spinal precautions had we found her on the floor (protocol) but the fall had happened about 3 hours prior and she ambulated with assistance of staff to our gurney and had been walking around since. C-spine precautions were long out the window. The center is staffed with RN's and they have their own O2 there if needed.

My only concern was her tiredness and dizziness but I think that was unrelated to the fall and more related to the reason she was in rehab.

 

[Medic Tim]

I agree. I would have done the spinal precautions had we found her on the floor (protocol) but the fall had happened about 3 hours prior and she ambulated with assistance of staff to our gurney and had been walking around since. C-spine precautions were long out the window. The center is staffed with RN's and they have their own O2 there if needed.

My only concern was her tiredness and dizziness but I think that was unrelated to the fall and more related to the reason she was in rehab.

you had to board her (protocol) even though there is no neck/back pain, 0 deficits, the fall was probably from less than 3 ft and she has been up moving around for 3 hours under an RNs care?...crazy (I wont say more on this as I dont want to get off topic)


Yeah she would have gotten a slow/easy ride to the ed from me, transported in the position of least discomfort. She probably would have gotten some fent as well.

 

[leoemt]

you had to board her (protocol) even though there is no neck/back pain, 0 deficits, the fall was probably from less than 3 ft and she has been up moving around for 3 hours under an RNs care?...crazy (I wont say more on this as I dont want to get off topic)


Yeah she would have gotten a slow/easy ride to the ed from me, transported in the position of least discomfort. She probably would have gotten some fent as well.

No, I would have boarded her had we responded and she was still on the floor as that is what the protocol states for an unwitnessed fall. Sorry for the confusion. At the point we arrived she had been up walking around for quite sometime.

I have no doubt she needed to be seen at the ER, but I don't think she needed the backboard or the Oxygen.

This was my first Syncope call so I was hoping I didn't miss something.

 

[abckidsmom]

What were her vital signs? What was the EKG? For what reason was she in the rehab place?

It sounds like there wasn't any reason for the oxygen to given, but we don't know the whole story here at all.

 

[sneauxpod]

I would have given her O2 because of the dizziness, i mean its not exactly necessary, but to me its kind of a "it cant hurt" situation.

 

[leoemt]

What were her vital signs? What was the EKG? For what reason was she in the rehab place?

It sounds like there wasn't any reason for the oxygen to given, but we don't know the whole story here at all.

I am a Basic so I don't do 12 leads.

The vitals were all normal for her age (27). I don't remember exact numbers but BP was about 118 / 76, RR 14, PERRL, Lungs clear all fields, HR was mid 70's normal and strong. Skin was Pink, warm, dry with no diaphoresis. She was A&Ox4. Her walk was of normal gait with no pain upon walking.

Drug addiction was why she was in rehab. I don't know what drug or how long she had been off. Didn't think to ask those questions at the time.

We don't do pulse ox in the field though the hospital makes us do it in the ER. She was 100% when we arrived.

The nurses immediately removed the back board and C-collar upon our arrival.

 

[Tigger]

I would have given her O2 because of the dizziness, i mean its not exactly necessary, but to me its kind of a "it cant hurt" situation.

Would you give her glucose too since that can't really hurt either?

 

[NYMedic828]

Would not have given her oxygen and I would probably have had her walk to the ambulance.

I would have given her O2 because of the dizziness, i mean its not exactly necessary, but to me its kind of a "it cant hurt" situation.

Are you certain it can't hurt? Or do you just think it can't hurt... In either instance, you would be mistaken.

 

[leoemt]

I would have given her O2 because of the dizziness, i mean its not exactly necessary, but to me its kind of a "it cant hurt" situation.

Dizziness can be caused by a lot of reasons, most of which O2 isn't going to help. I believe the dizziness was caused by her withdrawing from substance abuse and not a ground level fall. Since she was A&Ox4 and PERRL with no trauma to Head, Neck or Back, denying pain and no deformities upon palp I don't think there was any neurological deficit.

I don't like to do something "just because." It may be what the "book" says but its not how I operate. In Seattle, the doctors give us enough trust at the Basic level to make clinical decisions without consulting with them. When I walk into an ER I want to be able to tell the RN or MD exactly why I felt they needed a specific intervention, even if it is O2.

In this case I didn't see a need for the O2, but I will admit I am new and don't know everything. Maybe there is something about Syncope that I don't know which is why I bring this up.

Here in Seattle, the doctors and nurses are happy to answer our questions if they aren't busy so if you ask appropriate questions you can learn a wealth of information.

If I did everything the book said, every patient would get 15lpm by NRB.

 

[NYMedic828]

Dizziness can be caused by a lot of reasons, most of which O2 isn't going to help. I believe the dizziness was caused by her withdrawing from substance abuse and not a ground level fall. Since she was A&Ox4 and PERRL with no trauma to Head, Neck or Back, denying pain and no deformities upon palp I don't think there was any neurological deficit.

I don't like to do something "just because." It may be what the "book" says but its not how I operate. In Seattle, the doctors give us enough trust at the Basic level to make clinical decisions without consulting with them. When I walk into an ER I want to be able to tell the RN or MD exactly why I felt they needed a specific intervention, even if it is O2.

In this case I didn't see a need for the O2, but I will admit I am new and don't know everything. Maybe there is something about Syncope that I don't know which is why I bring this up.

Here in Seattle, the doctors and nurses are happy to answer our questions if they aren't busy so if you ask appropriate questions you can learn a wealth of information.

If I did everything the book said, every patient would get 15lpm by NRB.

Good to see your attitude towards assessment and treatment has evolved. Couple months ago your answer was protocols say so.

Now help get the word out

 

[mycrofft]

Would you give her glucose too since that can't really hurt either?

"Candy, Little Girl?".

Tell the FTO you are failing to find the protocol requiring oxygen ad lib without s/s.

 

[MassEMT-B]

There seems no reason for o2 besides giving it just because they passed out. If hypoxia was honestly the reason for the syncopal episode and dizziness there would be other outward signs of it. Just a question, would those who use the NEXUS c spine criteria consider the shoulder pain coupled with the clavicle deformity a distracting injury?

 

[NYMedic828]

There seems no reason for o2 besides giving it just because they passed out. If hypoxia was honestly the reason for the syncopal episode and dizziness there would be other outward signs of it. Just a question, would those who use the NEXUS c spine criteria consider the shoulder pain coupled with the clavicle deformity a distracting injury?

The clavicles are amongst the most easily fractured bones in the body. Due to the way the shoulder joint and the pectoral girdle meet with the clavicle when a person falls and uses their arm to brace themselves it often transfers the force to the clavicles and can cause fracture.

Many martial arts and self defense classes also advocate the clavicle as a primary striking point because it is so poorly supported and fracturing it results in disabling (usually) of the arm on the affected side.

Nice thing about the clavicles for us is that they are so anterior and rarely covered by much fat. A clavicular fracture is usually not too hard to palpate or even spot if the often distinct clavicular line seems "off."

If she had fractured the clavical you would probably know. That said, any true fracture is a porentially distracting injury but if you are assuming injury was caused by a fall, that would imply she landed on her shoulder or arm and not C-spine worthy. A fall from standing height is not worthy of suspecting spinal injury in a non-elderly patient. The human body by design is capable of such falls without injury. If there was a ladder next to the patient things are different...

 

[DrParasite]

I think the patient should have had a NRB at 15 lpm. that's what the book says right?

also, request a helicopter because the patient needs rapid transport to a level 1 trauma center.

 

[NYMedic828]

I think the patient should have had a NRB at 15 lpm. that's what the book says right?

also, request a helicopter because the patient needs rapid transport to a level 1 trauma center.

I think an F35 lightning is more appropriate. A helicopter is too slow.

I would suggest an F18, but its easier to land an F35 in a neighborhood...

 

[JPINFV]

I think an F35 lightning is more appropriate. A helicopter is too slow.

I would suggest an F18, but its easier to land an F35 in a neighborhood...

Easier? All planes are easy the land. As papa always says, haven't seen one stuck up there yet.

 

[NYMedic828]

Easier? All planes are easy the land. As papa always says, haven't seen one stuck up there yet.

:rofl: like cats in trees. Never see a dead cat in a tree.

Side note, the F35 does that nifty hovering take-off trick like a harrier.

 

[emtb31dcems]

ANSWER regards to OXYGEN

NO matter what I have always learned it never hurts to give oxygen via NC @ 2 lpm. Vital signs could have easily changed, you basically prevented from things getting worse. Your FTO was right.