Oxygen

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Veneficus

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wow

JDallas said:
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.
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Could I respectfully ask what you consider "skyrocketing?"

At what level do you consider them dangerously high?

JDallas said:
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).
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On medicine, no news is good news.

If you spend some time in a hospital, you will observe the most neglected patients are the least sick.

You know what is scary? Being the patient that is commanding everyone's attention.

However, I advocate always appearing calm and collected, it gives confidence to patients. When they see you have everything in control, they calm down.

Another thing that helps is explaining things to them. Like what is going to happen next, or the wait times, or what is going on with them.

JDallas said:
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.
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Such vitals are not clinically significant in most patient populations.

This to me appears to be fear of the unknown influencing your judgement. You or your mentors do not know what scary looks like so it becomes fear of everything.

JDallas said:
As for specific evidence, all I have to say is that my Captain (EMT-I, 20 years experience)
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I am not impressed.

JDallas said:
instructed me to do so and I have personally seen results.
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Regretably, I doubt it. Correlation does not equal causation.


JDallas said:
Keep in mind that its touch-and-go, and every patient reacts differently. Discontinue oxygen immediately if the patient isn't responding appropriately.
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Have you considered the oxygen you apply today may take time off of a patient's life decades later? That it may reduce the quality of their life faster and increase their medical bills over time? Have you considered the stress involved with the elderly, particularly on a fixed income and immobile, and the negative health influences of trying to pay for and navigate the health system are?

Let me put it into perspective?

lets say a 65 year old male over the course of his life has lost X% of pulmonary function to age and various pathology.

Let's assume that you put them on 15l of NRB and drive them 30 minutes to the hospital. During this time, you observe them calm down.

3 or 4 months later they develop shortness of breath. They return to the hospital where they are now diagnosed with more advanced pulmonary deficency. They are now not able to carry on their daily routine and their quality of life and maybe even their income is reduced. Perhaps their renal function or liver function as well.

Perhaps that person could have gone another 2-3 maybe 5 years without such a decrease if you hadn't overdosed him on oxygen?

Just something to think about...

JDallas said:
Above all, keep in mind that I am not an instructor, (I am) a doctor, (this too) or a renown scholar. (and this) It would be foolish to accept a new medical procedure based off of my statements.(I think I make some pretty good medical arguments and have some insight)
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VFlutter

VFlutter

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Veneficus is my hero :wub:
 
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Veneficus

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JDallas

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One specific call

On the specific call I mentioned with an HR of 120 and BP 150/100 (I belive, I don't have a perfect memory), maybe I should mention that the patient was an 80 year old inactive man., which is why those vitals concerned me.

Also, I do not advocate applying oxygen as a placebo. I ask the patient "Would you like me to start oxygen? It might help you calm down, but it won't benefit you much. Also, I highly doubt that 3 lpm over a 15 minute transport will cause an o2 overdose.

I'm not particularly interested in debating medicine with experts. My training is Basic (hence, I'm chatting in the Basic Life Support area) and I don't really want to embarrass myself in a high-level discussions with experts that have probably been experts for half of my life or longer. I will, however, speak with my medical director about this issue. If my usage of oxygen is innappropriate, I will discontinue the practice of using it to calm down patients. If not, I will continue to do what my department considers appropriate.

Thank you for the insights, and so long.
 
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Veneficus

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Achilles

Achilles

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since we are posting videos about sexy and smart,
http://www.youtube.com/watch?v=d7hzcLZ7uRc
[YOUTUBE]http://www.youtube.com/watch?v=lj3iNxZ8Dww[/YOUTUBE]

this is the best one [YOUTUBE]http://www.youtube.com/watch?v=NrzXLYA_e6E[/YOUTUBE]
 
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Aidey

Aidey

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EMT B said:
I noticed the term "free radicals" thrown around many times. I do not deem learning about those..can someone please shed some light as to what that is?
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deem

/dēm/
Verb
Regard or consider in a specified way.


I don't understand the rationale behind your question.
 
Tigger

Tigger

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JDallas said:
On the specific call I mentioned with an HR of 120 and BP 150/100 (I belive, I don't have a perfect memory), maybe I should mention that the patient was an 80 year old inactive man., which is why those vitals concerned me.

Also, I do not advocate applying oxygen as a placebo. I ask the patient "Would you like me to start oxygen? It might help you calm down, but it won't benefit you much. Also, I highly doubt that 3 lpm over a 15 minute transport will cause an o2 overdose.

I'm not particularly interested in debating medicine with experts. My training is Basic (hence, I'm chatting in the Basic Life Support area) and I don't really want to embarrass myself in a high-level discussions with experts that have probably been experts for half of my life or longer. I will, however, speak with my medical director about this issue. If my usage of oxygen is innappropriate, I will discontinue the practice of using it to calm down patients. If not, I will continue to do what my department considers appropriate.

Thank you for the insights, and so long.
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As someone (Christopher I think?) recently said, the plural of anecdote is not data.
 
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NYMedic828

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EMT B said:
Autocorrect much? I meant to say i do not remember. Awk...
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A free radical is essentially an atom with a missing electron in its outer valence shell. Any time an atom has an unpaired electron, or uneven number of electrons for that matter, it is considered to be unstable.

The stable form of Oxygen, is O2. It has 8 electrons in its outer valence shell.

The free radical of oxygen, otherwise known as "superoxide" is O2-. It has 7 electrons its outer shell.

That unpaired 7th electron readily binds to, or in the case of ON- "attacks" whatever it comes across. The problem is that superoxide doesn't care what it goes after. It just seeks and destroys.

White blood cells such as neutrophils release superoxide amongst other things in order to kill off unwanted cells.

Free radicals of oxygen essentially form as a product of natural body chemistry. The issue with supplemental oxygen administration is the body only knows what to do with 21% oxygen. When we give it an extra 79%, and it doesn't have anywhere to put it, more free radicals form.

Your body can combat some of them through "antioxidants" which essentially sacrifice themselves to be destroyed by O2- for the greater good of protecting the body.

If O2- becomes overwhelming, it will start causing damage to the lining of the alveoli (type I pnuemocytes), the endothelium of vessels and hepatocytes (liver cells) amongst whatever other tissues it may come into contact with.
 
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