Oxygen

[JPINFV]

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.

Sure. Now just never make an argument that EMS is a profession.

 

[paradoqs]

In my district, high fkow O2 is indicated for any suspected cardiac chest pain. Now, if my medical director wanted me to use clinical judgement, why didnt he put something in there about checking the pt's o2 sats/oxygenation before administering o2? I think alot of the issue derives from the old theory that oxygen will never hurt and once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change.
On another note, I had an ed rn freak out on me because i didnt take a bgl on a pt that was aaox3 with no diabetic hx and a c/c of abnormal labs. I told her a bgl wasnt indicated and my captain agreed with me later. She still expected a bgl though. I think if I bring her a pt with cardiac c/p who is satting fine and on no oxygen, she might try to take my head off.

 

[Tigger]

In my district, high fkow O2 is indicated for any suspected cardiac chest pain. Now, if my medical director wanted me to use clinical judgement, why didnt he put something in there about checking the pt's o2 sats/oxygenation before administering o2? I think alot of the issue derives from the old theory that oxygen will never hurt and once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change.
On another note, I had an ed rn freak out on me because i didnt take a bgl on a pt that was aaox3 with no diabetic hx and a c/c of abnormal labs. I told her a bgl wasnt indicated and my captain agreed with me later. She still expected a bgl though. I think if I bring her a pt with cardiac c/p who is satting fine and on no oxygen, she might try to take my head off.

So stand up tall and tell her you practice evidence based medicine. Don't be pushed around on patient care. What's the worst that happens, you get called in front of your medical director (unlikely) and then you have a discussion with the net result of him agreeing with you. If you are providing excellent care you have nothing to be afraid of.


Sent from my out of area communications device.

 

[Handsome Robb]

BGL is a standard vital sign for us. With that said if we don't start a line we usually won't get a BGL off them seeing as most cheat and snag our sample off the IV needle. Don't jump down my throat for CBG vs. VBG I know the difference.

With that said, there are more and more studies showing the detrimental effects of hyperoxygenation in cardiac patients. I wonder how long it will take for protocol based practices to catch on.

 

[paradoqs]

BGL is a standard vital sign for us. With that said if we don't start a line we usually won't get a BGL off them seeing as most cheat and snag our sample off the IV needle. Don't jump down my throat for CBG vs. VBG I know the difference.

I dont know the difference. Do you mean venous vs capilary? Please explain

 

[Handsome Robb]

I dont know the difference. Do you mean venous vs capilary? Please explain

Yes venous vs. capillary. Depending on what your glucometer is calibrated the reading may be off if you use a sample from the wrong source whether it be venous samples or capillary samples, venous usually being higher than capillary if I remember correctly.

 

[paradoqs]

Yes venous vs. capillary. Depending on what your glucometer is calibrated the reading may be off if you use a sample from the wrong source whether it be venous samples or capillary samples, venous usually being higher than capillary if I remember correctly.

We use either and dont differentiate between the two regarding the value.

 

[usalsfyre]

In my district, high fkow O2 is indicated for any suspected cardiac chest pain.

Just a quick word, it's not indicated no matter what district your in. It's just in your protocols.

Now, if my medical director wanted me to use clinical judgement, why didnt he put something in there about checking the pt's o2 sats/oxygenation before administering o2?

Honestly? Because likely he doesn't trust his providers medical judgement.

I think alot of the issue derives from the old theory that oxygen will never hurt and once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change.

Nail on the head. In the meantime though, we need to be LOBBYING to get these protocols changed.

On another note, I had an ed rn freak out on me because i didnt take a bgl on a pt that was aaox3 with no diabetic hx and a c/c of abnormal labs. I told her a bgl wasnt indicated and my captain agreed with me later. She still expected a bgl though. I think if I bring her a pt with cardiac c/p who is satting fine and on no oxygen, she might try to take my head off.

Just because they're an RN, or for that matter an MD doesn't mean they're a particularly great or up-to-date provider. I've had a "discussion" at bedside with a trauma surgeon before, he thought any analgesia was too much. The discussion ended when the patient told him he appreciated the fentanyl . Hold your ground if you've got the evidence to back it up.

 

[mint_condition]

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.

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.

 

[usafmedic45]

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

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

 

[usafmedic45]

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.

OK, can we agree that I have been "taught that way" to assume that you lack supratentorial function and apparently couldn't reason your way out of a harvested corn field because you weren't "taught to think that way?" :glare:

 

[usafmedic45]

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 does talking to them normally. Oxygen is not indicated for anxiety. It actually can worsen it.

i've never had a hypoxic pt

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.

Are you familiar with the phrase "contradiction of terms"?

 

[usafmedic45]

I dont know the difference.

I honestly get the feeling that this is a common occurrence based upon your previous post in this thread.

once studies begin to overwelmingly support the withholding of o2 unless truly necessary the protocols will start to change.

That happened quite a few years ago. Time to pull some studies and go make an appointment to talk with your medical director.

 

[JPINFV]

That happened quite a few years ago. Time to pull some studies and go make an appointment to talk with your medical director.

Shouldn't we withhold interventions until the studies shows them to be effective, not give interventions until studies show them to be harmful?

 

[usafmedic45]

Shouldn't we withhold interventions until the studies shows them to be effective, not give interventions until studies show them to be harmful?

Yes, but remember, this is EMS. It's all about what the protocols say and not about what is actually beneficial for the patient.

 

[mint_condition]

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

My friend has cluster headaches, the doctors prescribed her oxygen, so she has a tank in her room and she throws that on when she feels it come on

 

[usafmedic45]

My friend has cluster headaches, the doctors prescribed her oxygen, so she has a tank in her room and she throws that on when she feels it come on

Once again, I reiterate....does anyone have any evidence that it actually works? I've never seen any research comparing it to a placebo, etc.

 

[JPINFV]

Here are the studies listed in Up-To-Date regarding oxygen and cluster headaches. Not a lot of evidence, but to be honest, my bar for administering medications like oxygen is very low to begin with.

http://www.ncbi.nlm.nih.gov.proxy.westernu.edu/pubmed?term=19996400
http://www.ncbi.nlm.nih.gov.proxy.westernu.edu/pubmed?term=3885921
http://www.ncbi.nlm.nih.gov.proxy.westernu.edu/pubmed?term=18646121

There was another one, but Pubmed didn't have an abstract for it.

 

[usafmedic45]

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.

 

[Aidey]

Just because they're an RN, or for that matter an MD doesn't mean they're a particularly great or up-to-date provider.

+1

I just had a discussion with an ED doc about O2 in cardiac patients. Our protocols are now inline with AHA's recommendations, including the ones for O2. However, 9 times out of 10 when we bring the patients in they still get O2. I asked about it and the doc said that he was going to continue to do it becuase he had seen O2 decrease chest pain*, he hadn't seen any good studies indicating that it was harmful for the time they are in the ED, and because we need to try and squeeze though as much O2 as possible. I didn't even bother trying to discuss it further with him.

* In what world does an ACS patient ever get O2 in isolation? I'm sure it is the O2 doing it and not the nitro, ASA, heparin, palvix, metoprolol, fentanyl or whatever else the patient is getting.