Also consider that there may be a study involved, whch is why this is done in the ED and not prior.
The madness does not always reveal its method.
Oxygen Question
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Also consider that there may be a study involved, whch is why this is done in the ED and not prior.
The madness does not always reveal its method.
zmedic
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Tigger; said:
I guess it depends on the number. But I could see getting pissed after the 20th patient with a nonrespiratory complaint comes in on 02 "because their pulse ox was 20," and the machine has a poor wave form, or they are on 02 for a pulse ox of 93.
NYMedic828
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Realistically though you should treat them based on the environment they came out of and presenting symptoms.
The patient in the scenario was just dizzy I doubt we are concerned with ruling out hydrogen cyanide or carbon monoxide in a rehab facility bedroom with no other aided.
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I find the phrase "treat the patient, not the machine." to be plainly awful. If you cannot recognize the fact the a pusle ox is adjunct to your assessment and not the assessment, you have no business working.
I believe different types of smoking methods can cause up to 1/4 of your hemoglobin to be carboxyhemoglobin.
Can't confirm by looking have exam in morning and I shouldn't be posting this. However, food for thought.
How does increasing the percentage of inhaled oxygen increase oxygen consumption/usage by cells at normal atmospheric pressure in non-ischemic cells? I understand reperfusion injury but I am having a hard time understanding the harm in administering oxygen to someone who is not hypoxic.
NYMedic828
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NYMedic828 said:
The above.
+1000
We have many phrases such as this in EMS that are obviously intended for the lowest common denominator in education level. A little piece of me dies whenever someone says "BLS before ALS," for example haha
NYMedic828
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Vene will go on to further explain that these free radicals primarily cause damage the first cells they contact.
First they will attack the type 1 pnuemocytes which comprise a very thin layer of easily destroyed alveolar tissue, then enter the bloodstream causing damage to the interior epithelial walls of blood vessels and eventually damage the cells of the liver.
In infants the retina is always affected. You could be leading that newborn neonate towards impaired vision by putting a non-rebreather on them for a long trip...
First they will attack the type 1 pnuemocytes which comprise a very thin layer of easily destroyed alveolar tissue, then enter the bloodstream causing damage to the interior epithelial walls of blood vessels and eventually damage the cells of the liver.
In infants the retina is always affected. You could be leading that newborn neonate towards impaired vision by putting a non-rebreather on them for a long trip...
Why? You can't effectively treat a patient without BLS skills. Yes, ALS can do drugs and do advanced interventions, but it comes down to BLS.
Its not a Paramedic thing - Life comes down to the ABC's simple as that. A good paramedic will recognize the importance of BLS skills.
Without good BLS, ALS is worthless.
Same goes with "treat the patient, not the machine" noone is saying that machines and numbers aren't important. What the point is is for the provider to look at the entire picture from a clinical stand point. If you have a blood pressure of 80/60 is the patient showing signs and symptoms consistent with those readings?
Healthcare is a team effort made up of many varied educations. It isn't about one being better than the other - its about everyone working together. If I as a Basic do a poor assessment, then I have just made the Medic or Doctors job more difficult. All the fancy cardiac drugs will be worthless if I am performing poor CPR for example.
NYMedic828
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TheLocalMedic
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Why is this oxygen question a big deal? So the guy disagrees with his FTO about giving a patient a little O2, BIG DEAL! Don't try and pull the pseudo-intellectual card about free radicals and argue the what ifs... Unless the oxygen therapy is continued for a long time there really aren't any adverse effects. Please, find me ONE documented case where there has been real damage done by giving supplemental O2 during the course of a transport and I'll eat my hat.
Granted, there wasn't really a reason to give oxygen (or c-spine) but from the practical perspective, it really doesn't hurt them. Yeah yeah, I heard the glucose doesn't hurt either argument, so stow it, that argument is a straw man http://en.wikipedia.org/wiki/Straw_man and isn't equivalent. I agree that we should only treat (OMG, oxygen's a DRUG??) conditions as appropriate, but all this argument is just silly.
Hey buddy, just do as your FTO says, and then when you're doing things on your own you can change your treatment modalities as you see fit. If you want to give them O2, great! If not, then that's fine too! The number of cases where giving supplemental oxygen truly makes a difference are few enough, and I challenge any one of you to find me a case where foregoing supplemental oxygen resulted in harm.
Granted, there wasn't really a reason to give oxygen (or c-spine) but from the practical perspective, it really doesn't hurt them. Yeah yeah, I heard the glucose doesn't hurt either argument, so stow it, that argument is a straw man http://en.wikipedia.org/wiki/Straw_man and isn't equivalent. I agree that we should only treat (OMG, oxygen's a DRUG??) conditions as appropriate, but all this argument is just silly.
Hey buddy, just do as your FTO says, and then when you're doing things on your own you can change your treatment modalities as you see fit. If you want to give them O2, great! If not, then that's fine too! The number of cases where giving supplemental oxygen truly makes a difference are few enough, and I challenge any one of you to find me a case where foregoing supplemental oxygen resulted in harm.
NYMedic828
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Why is this oxygen question a big deal? So the guy disagrees with his FTO about giving a patient a little O2, BIG DEAL! Don't try and pull the pseudo-intellectual card about free radicals and argue the what ifs... Unless the oxygen therapy is continued for a long time there really aren't any adverse effects. Please, find me ONE documented case where there has been real damage done by giving supplemental O2 during the course of a transport and I'll eat my hat.
Granted, there wasn't really a reason to give oxygen (or c-spine) but from the practical perspective, it really doesn't hurt them. Yeah yeah, I heard the glucose doesn't hurt either argument, so stow it, that argument is a straw man http://en.wikipedia.org/wiki/Straw_man and isn't equivalent. I agree that we should only treat (OMG, oxygen's a DRUG??) conditions as appropriate, but all this argument is just silly.
Hey buddy, just do as your FTO says, and then when you're doing things on your own you can change your treatment modalities as you see fit. If you want to give them O2, great! If not, then that's fine too! The number of cases where giving supplemental oxygen truly makes a difference are few enough, and I challenge any one of you to find me a case where foregoing supplemental oxygen resulted in harm.
Typical EMS mentality. If we can't prove its our fault, it must not be!
I'm sure the pathologist with more knowledge than most of us combined has nooooo idea what he's talking about.
TheLocalMedic
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Typical EMS mentality. If we can't prove its our fault, it must not be!
I'm sure the pathologist with more knowledge than most of us combined has nooooo idea what he's talking about.
Again, I challenge you to provide me with any real information besides speculation or anecdotes or disparaging comments to refute my argument. And to that end, please find me any pathologist who will commit to the idea that giving supplemental oxygen for the limited amount of time we are with a patient may be harmful. Seriously.
And not that I would have given O2 to this patient (I actually seldom find myself giving it to anyone), but it really is not going to "shave years off of their life" or give them cancer or cause birth defects or make the US dollar depreciate in value or anything.
NYMedic828
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Its rare to find ANY study related to pre-hospital care let alone one on oxygen.
I challenge you to prove to me that we don't cause damage. The discovery that oxygen causes damage hasn't been around that long. EMS is the last to pick up on just about everything. It hasn't made its way to us yet.
Can you prove that it doesn't cause cancer? birth defects? retinal damage?
All it takes is a patient with a low bodily reserve of antioxidants to combat free radicals, such as sick patients, you know, the kind who call an ambulance sometimes... Maybe like those with cancer or COPD and you could be causing damage off the bat.
Would you rather take a risk for no reason or would you rather administer a treatment that is appropriate and isn't just "because we can." That is the difference between a technician and a "clinician" if you will.
http://www.ncbi.nlm.nih.gov/pubmed/12570108
+1 for pseudo-intellectualism.
There are limitations of this study, but people should inform themselves. I have other stuff to do than explain.
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Granted, there wasn't really a reason to give oxygen (or c-spine) but from the practical perspective, it really doesn't hurt them. Yeah yeah, I heard the glucose doesn't hurt either argument, so stow it, that argument is a straw man http://en.wikipedia.org/wiki/Straw_man and isn't equivalent. I agree that we should only treat (OMG, oxygen's a DRUG??) conditions as appropriate, but all this argument is just silly.
I fail to see how that is a straw man. You said it yourself, we should only treat conditions as appropriate. In this case O2 was not appropriate. It was given under the guise of "well it can't hurt, let's make it look like we are doing something." The same thing could absoultey be done with glucose, but for some reason that's a real drug and O2 is not.
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Medicine is not about skills. Unfortunately, EMS is but that's a whole different rant. Medicine is medicine, BLS and ALS are artificial distinctions. Someone with the knowledge necessary for the use of ALS interventions does not need to delineate between the two, but rather they use whatever is the most appropriate. If the most appropriate intervention happens to be "ALS" in nature, they do not first go through the "BLS" side of things. No, they do what is effective, and then they are done.
Tigger already answered this for me - "Medicine is medicine, BLS and ALS are artificial distinctions." The paramedic's assessment and treatment plan includes "BLS", but those skills are integrated with "ALS," not first do BLS then move on to ALS.
For example, I'm not going to get a BP on an actively seizing pt before treating - I'm getting someone on airway/breathing while I'm drawing up Versed. Same for the hypoglycemic pt. If I get the line before someone gets to the BP, the D50's going in. We titrate our BVM ventilations to an ETCO2 of 35-45 for the head trauma pt with signs of herniation, not some arbitrary rate mandated by BLS protocols. I want a 12-lead before O2 (if we even end up giving it at all) and NTG admin unless the pt has respiratory distress/failure. If I have a pt in anaphylactic shock, I'm throwing epi into them as soon as I can get it drawn up, without delay. Maybe my partner can get some O2 on them in the meantime, but probably nothing else before I'm sticking them in the thigh. How about pain management before splinting?
Most of the time the things BLS are trained to do will occur before the things medics are trained to do will occur, but that's not always the case. Again, the line between BLS and ALS is arbitrary for the medic. I don't break up my assessment an Tx decisions into these categories.
BTW, if you're ever on the scene before ALS, rest assured the medics will always do their own full assessment at some point, probably right away. It doesn't matter much how good or bad your assessment is. Same goes for the doctor and nurses taking the pt from medics at the ED.
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TheLocalMedic
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As for Silver's study he provided as an exemplar, it still begs the question; While the "markers of oxidative stress" were increased in patients placed on supplemental oxygen, was there any real harm done to those test subjects? Sure, if our entire atmosphere were oxygen-enriched we would undoubtedly see ill effects, but were there any identifiable physical detriments to these patients? As a corollary, how quickly did these markers then fall back to a normal baseline following the termination of the supplemental oxygen? What I mean to ask is, as before, can you find me any case where the administration of O2 - for the length of time that we are with a patient - has done any real harm to a patient? Argue with me all you like about free radicals and antioxidants, but bear in mind that theoretical medicine still does not trump the establishment. I do not care for arguments that provide a "maybe" or a "possibly", but rather for ones that can provide concrete data that can be reproduced.
"Induced hyperoxia is potentially toxic, since it may increase oxidative stress and peroxidative damage to deoxyribonucleic acid, lipids and proteins."
Shall I highlight the words 'potentially' and 'may'? Find me proof! And hopefully not in the form of a 'maybe'!
As for the argument proffered by Tigger, I reassert that the argument about glucose administration being comparative to that of oxygen is in fact a Straw Man argument. Not only is the means of administration different, but glucose has a greater and longer lasting metabolic effect than does oxygen. Giving oxygen to a patient who has a PaO2 of 100 mmHg is not equivalent to giving a patient with a BGL greater than 120 mg/dl glucose or dextrose. There are differences both with administration and effect, so there is no good comparison. If I were to accept this comparison, then should I also accept the following?
A: Sunny days are good.
B: If all days were sunny, we'd never have rain, and without rain, we'd have famine and death.
"Induced hyperoxia is potentially toxic, since it may increase oxidative stress and peroxidative damage to deoxyribonucleic acid, lipids and proteins."
Shall I highlight the words 'potentially' and 'may'? Find me proof! And hopefully not in the form of a 'maybe'!
As for the argument proffered by Tigger, I reassert that the argument about glucose administration being comparative to that of oxygen is in fact a Straw Man argument. Not only is the means of administration different, but glucose has a greater and longer lasting metabolic effect than does oxygen. Giving oxygen to a patient who has a PaO2 of 100 mmHg is not equivalent to giving a patient with a BGL greater than 120 mg/dl glucose or dextrose. There are differences both with administration and effect, so there is no good comparison. If I were to accept this comparison, then should I also accept the following?
A: Sunny days are good.
B: If all days were sunny, we'd never have rain, and without rain, we'd have famine and death.