Oxygen

[JPINFV]

I looked at Pubmed but just saw a lot of subjective studies where the patient reported relief but it didn't seem (at least from the abstracts) that there was a control group.

BTW, the links you gave are restricted because they include the proxy server for your school.

Let's try this again....
http://www.ncbi.nlm.nih.gov/pubmed?term=19996400
http://www.ncbi.nlm.nih.gov/pubmed?term=18646121
http://www.ncbi.nlm.nih.gov/pubmed?term=3885921

 

[usafmedic45]

Let's try this again....
http://www.ncbi.nlm.nih.gov/pubmed?term=19996400
http://www.ncbi.nlm.nih.gov/pubmed?term=18646121
http://www.ncbi.nlm.nih.gov/pubmed?term=3885921

Thanks JP. I guess I was mistaken.

 

[Tigger]

maybe its because i work in LA for an non-emergency BLS company, and i've never had a hypoxic pt, but i do pick up a lot of anxious its and pt's in some pain going in as direct admits and i'll put them on 2-4 lpm, and it almost ALWAYS helps the pt's with anxiety. so i dont see what you mean when you say it helps reduce perceived pain or anxiety; when i get to my destination my pt always seems to feel a little better than when i picked them up. as i go along reading this, i find that there are a lot of good points, and a lot of ignorant points. not saying that your point is ignorant Tigger, just saying i've read some. i will never put O2 on a pt. that doesnt have any indication of needing it, but quite a few of my pt's get O2.

It is not ignorant, despite your ancedotal accounts to the contrary, to say that oxygen does not help the patient's anxiety level. It doesn't it doesn't it doesn't. What might be helping is the fact that the patient is comforted by the fact that they are on the way to the hospital and believe they are being cared for by a professional.

You could give a patient glucose and it might calm them down because they think they're getting some sort of helpful medication. But you don't do that right?

 

[J. Burdett]

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.

I concur

Neonates w/ L ventricular hypoplastic syndrome rely on a patent ductus arterious for systemic perfusion most of the time. When given high flow O2 the resulting vasoconstriction closes the PDA which results in death. Which is bad.

So if you get a call for a "blue baby" and find out that the newborn was born outside of the hospital (rural or low income areas mainly) w/ SpO2 in the 60's which gets worse w/ high flow O2 this might be something to consider.

Also, due to vasoconstriction, high flow O2 can cause blindness in neonates.

 

[J. Burdett]

Really....any evidence that it actually works? In 16 years, I've never seen it work.

I have

46 yo male w/ hx of cluster migraines received 15lpm NRB and was asymptomatic before our arrival at the ER. Pretty simple physiology behind why it's therapeutic.

 

[usalsfyre]

I have

46 yo male w/ hx of cluster migraines received 15lpm NRB and was asymptomatic before our arrival at the ER. Pretty simple physiology behind why it's therapeutic.

N=1

Cluster headaches tend to be self limiting anyway

 

[usafmedic45]

When given high flow O2 the resulting vasoconstriction closes the PDA which results in death. Which is bad.

It doesn't always result in death so you could phrase that better. It worsens the clinical condition and death is a rare occurrence.

Neonates w/ L ventricular hypoplastic syndrome

You know that that's not the only condition where this is a factor correct? Also, it's called hypoplastic left heart syndrome since very seldom is the ventricle the only structure affected. Usually the aorta and the valves on the left side of the heart (mitral and aortic) are also effected.

I have

46 yo male w/ hx of cluster migraines received 15lpm NRB and was asymptomatic before our arrival at the ER. Pretty simple physiology behind why it's therapeutic.

I said 'evidence' not a testimonial.

So if you get a call for a "blue baby" and find out that the newborn was born outside of the hospital (rural or low income areas mainly) w/ SpO2 in the 60's which gets worse w/ high flow O2 this might be something to consider.

Actually the SpO2 can rise or stay the same (at least initially), but the clinical condition deteriorates and THEN the SpO2 may plummet.

Also, due to vasoconstriction, high flow O2 can cause blindness in neonates.

Once again, it's a rare complication and is normally only seen in extremely long term O2 use. It's not something we should be all that concerned about in the field. By the way, O2 is only a risk factor for the condition (retinopathy of prematurity), not a direct cause of it. Hypoxia is also a risk factor for it since it's most likely due to a complicated mix of issues which result in a fibrovascular proliferation of the retinae. Saying it's due to O2 therapy is a bit like saying that being a member of EMTLife predisposes one to being an EMT. It doesn't mean that one is or will become one, but there is a strong correlation with it. Understood?

Your posts on this thread tend to serve as a perfect example of why a little bit of knowledge on a topic can be a very dangerous thing.

 

[AmeriMedic21]

yeah, its not always needed on everybody, but here is what i do. Sometimes i have those pts that are anxious, and when you sell oxygen in a sense that it will "make them feel better", and you apply it, they miraciously feel better, its kind of like the placebo effect i guess. I know what you mean though, my partner puts it on everybody, and i can sometimes get selective, considering im the only one who changes the big 02 tank on our truck. lol

 

[Tigger]

yeah, its not always needed on everybody, but here is what i do. Sometimes i have those pts that are anxious, and when you sell oxygen in a sense that it will "make them feel better", and you apply it, they miraciously feel better, its kind of like the placebo effect i guess. I know what you mean though, my partner puts it on everybody, and i can sometimes get selective, considering im the only one who changes the big 02 tank on our truck. lol

Why not give them glucose then? It's lighter and easier to restock than 02.

 

[J. Burdett]

It doesn't always result in death so you could phrase that better. It worsens the clinical condition and death is a rare occurrence.

I've seen it cause death but yes, you are correct, it does not always cause death. I was merely stating the severity of doing such. Try not to be so literal

You know that that's not the only condition where this is a factor correct? Also, it's called hypoplastic left heart syndrome since very seldom is the ventricle the only structure affected. Usually the aorta and the valves on the left side of the heart (mitral and aortic) are also effected.

I do know that it's not the only condition. I know a lot of things. You know that was a very poor question correct?

I said 'evidence' not a testimonial.

Someone posted evidence. Just thought I would let you know about my experience. Obviously you took it as an insult which I did not intend. I actually know a lot about the subject and was taught by a good friend who is a neurosurgeon. It's pretty interesting stuff.

Actually the SpO2 can rise or stay the same (at least initially), but the clinical condition deteriorates and THEN the SpO2 may plummet.

Actually it can not change at all and then fall. Speaking from experience.

Once again, it's a rare complication and is normally only seen in extremely long term O2 use. It's not something we should be all that concerned about in the field. By the way, O2 is only a risk factor for the condition (retinopathy of prematurity), not a direct cause of it. Hypoxia is also a risk factor for it since it's most likely due to a complicated mix of issues which result in a fibrovascular proliferation of the retinae. Saying it's due to O2 therapy is a bit like saying that being a member of EMTLife predisposes one to being an EMT. It doesn't mean that one is or will become one, but there is a strong correlation with it. Understood?

I did state that high flow O2 "can" cause blindness. Which it can. Which you know. So what are you trying to argue about?

Your posts on this thread tend to serve as a perfect example of why a little bit of knowledge on a topic can be a very dangerous thing.

I actually have a lot of knowledge on the subject. If you have any questions feel free to private message me. I think it's safe to say that we both know that, but you are attempting to goad me in to a argument. Nice try

............

 

[patzyboi]

Oxygen is only indicated when there is clinically demonstrable hypoxia (either via SpO2 or by overt clinical signs like cyanosis or pallor) or in cases of known or strongly suspected CO toxicity. With the exception of CO toxicity (where 15 L/min or more via a NRB is indicated until you get the patient to a hyperbaric facility), the lowest amount of oxygen necessary to achieve a saturation >90% is all that should be used.

O2 does do harm and it has been shown to worsen clinical outcomes when used inappropriately.

Can you elaborate on the harm part here? I know COPD patients administering low amounts of oxygen over a period of time is ideal, but you shoudnt even withhold O2 if they are hypoxic

 

[VFlutter]

What a Gem of a thread. Thanks for bringing it back from the dead

 

[CANDawg]

What a Gem of a thread. Thanks for bringing it back from the dead

 

[Anjel]

Can you elaborate on the harm part here? I know COPD patients administering low amounts of oxygen over a period of time is ideal, but you shoudnt even withhold O2 if they are hypoxic

He isn't allowed on this forum anymore. Maybe someone else could answer though. I tired.

 

[Achilles]

Can you elaborate on the harm part here? I know COPD patients administering low amounts of oxygen over a period of time is ideal, but you shoudnt even withhold O2 if they are hypoxic

SOunds like you're a basic?

Answer. give o2 transport.

 

[JDallas]

Well, since this thread is back from the dead, I'll chime in...

Never EVER EVER give a patient unneeded medication (o2, IV, Band-Aid, ANYTHING).

I have seen o2 have a beneficial phsyciatric (spell check?) effect. As a healthcare provider, don't we need to attend to ALL aspects of patient care? Applying oxygen can calm patients down, possibly lowering high pulse/BP caused by anxiety, and potentially prevent complications.

 

[Aidey]

I have seen o2 have a beneficial phsyciatric (spell check?) effect. As a healthcare provider, don't we need to attend to ALL aspects of patient care? Applying oxygen can calm patients down, possibly lowering high pulse/BP caused by anxiety, and potentially prevent complications.

Psychiatric is the correct spelling, the word you actually want is either psychogenic or placebo and cite your source saying that oxygen can calm patients down and what complications are potentially prevented. A source explaining how oxygen can do this better than say talking calmly to the patient or holding their hand would also be helpful.

 

[JDallas]

Psychiatric is the correct spelling, the word you actually want is either psychogenic or placebo and cite your source saying that oxygen can calm patients down and what complications are potentially prevented. A source explaining how oxygen can do this better than say talking calmly to the patient or holding their hand would also be helpful.

When a patient is stressed out (as they likely are during transport, its a very scary thing), their vitals can skyrocket... surely, you're aware of this.

When the patient belives that the EMT is actively treating them instead of just kicking back and watching, they calm down and the vitals begin to return to a normal range (typically).

As for potentially prevented complications... A pulse of 120 and BP of 150/100 (I have experienced this situation) places unnecesary strain on the cardiovascular system, which should be prevented, IF POSSIBLE, by the EMS crew.

As for specific evidence, all I have to say is that my Captain (EMT-I, 20 years experience) instructed me to do so and I have personally seen results. Keep in mind that its touch-and-go, and every patient reacts differently. Discontinue oxygen immediately if the patient isn't responding appropriately.

Above all, keep in mind that I am not an instructor, a doctor, or a renown scholar. It would be foolish to accept a new medical procedure based off of my statements.

 

[NYMedic828]

When a patient is stressed out (as they likely are during transport, its a very scary thing), their vitals can skyrocket... surely, you're aware of this.

When the patient belives that the EMT is actively treating them instead of just kicking back and watching, they calm down and the vitals begin to return to a normal range (typically).

As for potentially prevented complications... A pulse of 120 and BP of 150/100 (I have experienced this situation) places unnecesary strain on the cardiovascular system, which should be prevented, IF POSSIBLE, by the EMS crew.

As for specific evidence, all I have to say is that my Captain (EMT-I, 20 years experience) instructed me to do so and I have personally seen results. Keep in mind that its touch-and-go, and every patient reacts differently. Discontinue oxygen immediately if the patient isn't responding appropriately.

Above all, keep in mind that I am not an instructor, a doctor, or a renown scholar. It would be foolish to accept a new medical procedure based off of my statements.

A BP of 150/100 and a HR of 120 is considerably low when you consider a person actively running can sustain a HR of 150-200. Unless there is a cardio-pulmonary or hemodynamically compromising pathology suspected those vitals aren't clinically significant other than to affirm a patient is in fact experiencing a behavioral issue.

Oxygen is an actual drug. We give it when indicated and only then.

Sugar pills are a placebo.

Sorry but your captain is mistaken. Just because someone has done something for 20 years doesn't mean they've been doing it right.

 

[VFlutter]

To quote Vene, experience does not equal understanding. Giving oxygen to a patient who is not hypoxic is a medication error, plain and simple. Maybe you should just tell your patients that the saline flushes are medicine, ya know for the placebo effect.

But then again I ain't no scholar either