Oxygen

[fast65]

You both make valid points.

Let's just agree to disagree.

The end to yet another discussion

 

[Tigger]

Yes, O2 is normally withheld until indicated. However, I don't completely agree with that. If you have a Pt who's in pain, dyspnoeic, or with any other complaint than you need to do something; anything. Simply putting them in your truck & monitoring vitals en-route isn't sufficient.

No, putting them in your truck and transporting without 02 is sufficient, provided that a thorough assessment has been completed and the patient is no respiratory distress. Oxygen is not harmless, I don't care if that's how someone has been trained, it is not proper patient care to provide a medication that is not indicated. As a basic working on a BLS truck, I'll be the first to remark that it sucks to have a patient in pain and be unable to do anything but transport in a position of comfort. But at my present level of training, I have no other options.

I almost always tell my Pt's something like, "Sir, I'm going to give you a little bit of Oxygen; not because you're in any kind of respiratory distress but because sometimes the Oxygen helps to diminish (pain, dyspnea, anxiety, etc...)

If that Pt believes that the 02 will help them then, in their mind, it's going to. Even if it doesn't relieve any actual symptoms, their mind tends to focus less on whatever complaint they have because they believe that your intervention is helping them.

So you're lying to your patients then? That is violating the trust of your patient, whether they aware of it or not. Oxygen in itself does not reduce pain or anxiety in itself. Being in the care of a professional care giver might help reduce perceived pain levels or anxiety, but oxygen will not.

On that note, NEVER say that (Insert intervention here) is GOING to help because, when it doesn’t; you’ll become a liar and lose the Pts trust & confidence.

Speaking of becoming a liar and losing the patients trust...

 

[usalsfyre]

You both make valid points.

Let's just agree to disagree.

The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.

 

[fast65]

The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.

I will agree with your disagreeing to his agreeing to disagree.

 

[Tigger]

The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.

+1. If you post something, you better be able to defend it. If this discussion was between you and your medical director (which it is clearly not), would the "agree to disagree and walk away option" exist? No of course not. If you can't rationalize and defend your treatment, you need to reconsider what you're doing to your patient.

As the fat man says, "doing nothing is doing something."


Sent from my out of area communications device.

 

[JPINFV]

As the fat man says, "doing nothing is doing something."

Rule 13: The delivery of good medical care is to do as much nothing possible.

 

[abckidsmom]

I will agree with your disagreeing to his agreeing to disagree.

I agree with your agreeing with his disagreeing with his agreeing to disagree.

 

[JPINFV]

I agree with your agreeing with his disagreeing with his agreeing to disagree.

I disagree to disagree with your agreeing with his agreeing with his disagreeing with his agreeing to disagree.

 

[fast65]

I disagree to disagree with your agreeing with his agreeing with his disagreeing with his agreeing to disagree.

I agree to your disagreeing to disagree with her agreeing with my agreeing with his disagreeing with his agreeing to disagree

 

[Chief Complaint]

Hah. You guys are giving me a headache...

Im gonna put on my NRB and crank it up until it goes away.

 

[CAOX3]

Hah. You guys are giving me a headache...

Im gonna put on my NRB and crank it up until it goes away.

We actually administer oxygen to patients with migraines/cluster headaches with great sucess.

 

[EMTswag]

This stuff does my head in. I must applaud you for not being another one of the "oxygen can't do any harm" group, you sir are one of the few it seems. Makes me want to crack people around the bloody head with the oxygen tank, seriously.

Oxygen is only indicated for those who are acutely hypoxic (SpO2 < 95% on RA) the exception being those patients with COPD as they often have chronically low SpO2, lowest I've seen is in the high seventies.

Like with anything, clinical judgement is required; somebody who is blue in the face and struggling to breath but has an SpO2 of 100% clearly needs oxygen, somebody who has an SpO2 of 50% (arbitrary number) but who is pink, speaking in full sentences and well perfused doesn't need oxygen.

Hyperoxaemia/oxygen in supraphysiological amounts is really bad news for the following groups of patients and it's most important that oxygen should not be administered to them unless hypoxic: premature newborns, neonates, stroke, and myocardial infarction. The reasoning behind premature newborns, stroke and MIs is that oxygen in supraphysiological amounts causes small capilaries and arterioles to constrict which will reduce blood supply, for newborns I am told there is "some evidence" (none I have personally reviewed) that oxygen makes outcomes worse.

Now, are you against o2 on the suspected MI all together or are you against high flow o2 on the suspected MI?

 

[JPINFV]

Now, are you against o2 on the suspected MI all together or are you against high flow o2 on the suspected MI?

I'm against O2 in patients who are neither hypoxic nor in respiratory distress. Ischemia and hypoxia is not the same thing.

 

[Sasha]

If the problem is a blockage you can put them on 30lpm you're still not going to get oxygen to the ischemic tissue.

Sent from LuLu using Tapatalk

 

[EMTswag]

I'm against O2 in patients who are neither hypoxic nor in respiratory distress. Ischemia and hypoxia is not the same thing.

Okay yeah just clarifying I happen to agree with you. As it happens though a lot of times, as you undoubtedly know, an MI or even any sort of chest pain has some associated SOB that would be treatable, not necessarily with 15lpm, but some application of o2.

Then again, I've brought many a patient into the ER with chest pains and no associated SOB and gotten questioned as to why my pt wasn't on o2.

On a related note, I had a partner put a pt with back pain secondary to a minor fall on 15 lpm nrb... :glare:

 

[cad2830]

The problem with agreeing to disagree in this case is that you have no evidence to back up your position, yet you continue to insist to provide unindicated treatments to patients because you were "taught that way". This hear no evil, see no evil, speak no evil attitude drags EMS down, and because all of us are associated with EMS it drags all of our names through the mud.

I disagree with that. Because I was "taught that way" is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.

I. Perform initial assessment.
II. Assure that the patient’s airway is open and that breathing and circulation are adequate.
III. Administer high concentration oxygen, suction as necessary, and be prepared to assist ventilations.
IV. Position patient with head and chest elevated or position of comfort, unless doing so
compromises the airway.
V. Perform Cincinnati Pre-Hospital Stroke Scale:
A. Assess for facial droop: have the patient show teeth or smile,
B. Assess for arm drift: have the patient close eyes and hold both arms
straight out for 10 seconds,
C. Assess for abnormal speech: have the patient say, “you can’t teach an old
dog new tricks"

 

[fast65]

I disagree with that. Because I was "taught that way" is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.

Sorry, that's just a terrible excuse. If you want to be taken seriously by your peers you need to use something called "clinical judgement". Applying oxygen just because the protocol says to is not an example of that.

 

[Akulahawk]

I disagree with that. Because I was "taught that way" is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.

Your protocols were developed by people that have more experience and knowledge that you do... for those providers that are barely at the 8th grade reading level - and don't want to improve that. Think lowest common denominator... many providers are WELL above that and could apply good judgment.

Sorry, that's just a terrible excuse. If you want to be taken seriously by your peers you need to use something called "clinical judgement". Applying oxygen just because the protocol says to is not an example of that.

And I agree (and will go further than that) that "because that's what I was taught and my protocols say so" makes for worse than terrible clinical judgment. It's NO clinical judgment. That's "cookbook medicine". While your protocols generally must be followed to the letter, good clinical judgment may involve selecting several different protocols to run simultaneously on your patient. Good clinical judgment may mean having to place your patient on a high concentration of O2 knowing that current best practices indicate that low flow or no flow is properly indicated and doing what you must do to keep your certificate/license... and relaying to the receiving medical team that you had to apply oxygen to that patient per protocol and you believe that your patient doesn't need greater than room air concentrations.

If I'm following a specific protocol, it's because I have evaluated the patient, determined what's wrong within my knowledge base, and determined that a specific protocol would best fit the patient's problem at the moment... and that I don't need to call for a base to get an order to implement a different plan (not in the "book") or modify an existing protocol to fit the issue at the moment.

Just following the book blindly is not using good clinical judgment... a robot could do that. EMS providers are human, and not robots, because we can think.

 

[Aprz]

Some protocols have a disclaimer saying that they are just guideline, and to use sound judgement when you can. That's what it is like where I live.

 

[Tigger]

I disagree with that. Because I was "taught that way" is a good reason. I was taught to my local protocols. The protocols were developed by people that have far more experience and knowledge than I do. Virtually all of our protocols have O2 in the first couple of steps.

No, that is an awful reason to do anything, especially medicine. Note that the protocols you posted include the verbiage "as necessary." That gives you some leeway to make clinical decision making. If oxygen is not indicated, why would you give it?

If gluctose was not indicated would you still give it? There aren't really any serious effects....

If you're on BLS truck and you have a sick patient, sometimes there are no interventions available for you. Welcome to being a low-level provider, where sometimes your best treatment is blankets, pillows, and holding someone's hands. And calling for medics or getting to the hospital without delay.

Doing "nothing" is the right thing to do if the only tools at your disposal also do nothing for your patient.