Oxygen

Anjel said:
Oh lord... No!

Oxygen can hurt! High flow o2 is contraindicated in stroke and Myocardial Infarction. Look it up.
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Explain how an EMT-B is supposed to field diagnose an AMI? Chest pain and Neuro protocols basically order you to use O2 anyways.
 
EMT856 said:
Explain exactly how 20-30 minutes of oxygen is exactly what is wrong with EMS as a whole?
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The philosophy it's not gonna hurt so why not do it. That's being a protocol monkey. You are allowed to think, and think of why you are giving oxygen, and how it will effect the body. You might not see any negative effects while you have them for 20-30 minutes, but it is doing more harm than good.
 
EMT856 said:
Explain exactly how 20-30 minutes of oxygen is exactly what is wrong with EMS as a whole?
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I think what they are referring to is EMS giving O2 without having a justification because "it can't hurt". In the medical field justification is supremely important. If someone gives O2 "just cuz" what impression does that give? That we will do things without a good reason.
 
Anjel said:
The philosophy it's not gonna hurt so why not do it. That's being a protocol monkey. You are allowed to think, and think of why you are giving oxygen, and how it will effect the body. You might not see any negative effects while you have them for 20-30 minutes, but it is doing more harm than good.
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Studies have been done by those with Medical Degrees, the ones who write the protocols that we all should at least consider, that have shown that prehospital high flow oxygen is not going to cause any ill effects. We do not know in the field what is going on for certain no matter how much we think we do most of the time. Yes, I can think for myself, and If I think there is potential for benefit for the patient, I am willing to try it.
 
Glucatron said:
I think what they are referring to is EMS giving O2 without having a justification because "it can't hurt". In the medical field justification is supremely important. If someone gives O2 "just cuz" what impression does that give? That we will do things without a good reason.
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I am not by any means saying just do it because you can, but if you think that it might be of use, then use it.
 
EMT856 said:
Studies have been done by those with Medical Degrees, the ones who write the protocols that we all should at least consider, that have shown that prehospital high flow oxygen is not going to cause any ill effects. We do not know in the field what is going on for certain no matter how much we think we do most of the time. Yes, I can think for myself, and If I think there is potential for benefit for the patient, I am willing to try it.
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You seriously have no idea what you are talking about, and I am not going to waste my time arguing. If you do a simple google search, you will find tons of studies by people with real medical degrees, talking about how hyperoxia is dangerous.
 
Anjel said:
You seriously have no idea what you are talking about, and I am not going to waste my time arguing. If you do a simple google search, you will find tons of studies by people with real medical degrees, talking about how hyperoxia is dangerous.
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Yes, I know it is dangerous in a longer term exposure. I am saying if you are in doubt or unsure then putting someone on HF 02 for 10-30 minutes until a doctor or other advanced practitioner can make the assessment that they dont need it, you are not going to do any damage.
 
Ok let's say you are having a stroke. Your brain is oxygen deprived. Because there is a clot. Now when you give someone high flow o2 it causes vasoconstriction. Your body is like "oh hey we have all the o2 we need, no need to make these vessels any bigger".

So now you are constricting blood vessels in the brain, that are already blocked. Any blood getting through before isn't any more. So you are making it worse. Now say you have a 15 minute transport time. For 15 minutes you have an even more oxygen deprived brain. That can hurt them.

I'm obviously over simplifying this. But all national standards state to never give a stroke patient high flow o2.
 
Anjel said:
Ok let's say you are having a stroke. Your brain is oxygen deprived. Because there is a clot. Now when you give someone high flow o2 it causes vasoconstriction. Your body is like "oh hey we have all the o2 we need, no need to make these vessels any bigger".

So now you are constricting blood vessels in the brain, that are already blocked. Any blood getting through before isn't any more. So you are making it worse. Now say you have a 15 minute transport time. For 15 minutes you have an even more oxygen deprived brain. That can hurt them.

I'm obviously over simplifying this. But all national standards state to never give a stroke patient high flow o2.
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And the AHA and ACLS support this. I'll reply back in a bit with a better response to some of the above when I get to a computer. I need to get the links to some studies
 
Anjel said:
Ok let's say you are having a stroke. Your brain is oxygen deprived. Because there is a clot. Now when you give someone high flow o2 it causes vasoconstriction. Your body is like "oh hey we have all the o2 we need, no need to make these vessels any bigger".

So now you are constricting blood vessels in the brain, that are already blocked. Any blood getting through before isn't any more. So you are making it worse. Now say you have a 15 minute transport time. For 15 minutes you have an even more oxygen deprived brain. That can hurt them.

I'm obviously over simplifying this. But all national standards state to never give a stroke patient high flow o2.
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Now lets say protocols say put patient on 02, and you dont. Patient dies anyways, but now you are liable because you didnt follow protocols. My AMS protocol states any pt with AMS gets oxygen.
 
TransportJockey said:
And the AHA and ACLS support this. I'll reply back in a bit with a better response to some of the above when I get to a computer. I need to get the links to some studies
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Well, then I guess they need to revise a lot of protocols. I am sorry if y'all have different protocols but I am basing my responses on the protocols that I have worked with my entire career.
 
EMT856 said:
Now lets say protocols say put patient on 02, and you dont. Patient dies anyways, but now you are liable because you didnt follow protocols. My AMS protocol states any pt with AMS gets oxygen.
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Oxygen yes. But but not high flow! O2 isn't an all or nothing sort of thing. You can use nasal cannulas. That's why we have them.
 
Anjel said:
Oxygen yes. But but not high flow! O2 isn't an all or nothing sort of thing. You can use nasal cannulas. That's why we have them.
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I was taught to use NRB first and NC if they cant tol. a NRB. This wasnt that long ago either.
 
EMT856 said:
I was taught to use NRB first and NC if they cant tol. a NRB. This wasnt that long ago either.
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I can count on one hand the amount of times I've used an NRB lately that hasn't had a neb chamber on it. If anything most of my sick patients get a nasal cannula just so I can monitor etco2.

And as for you post about protocols, when you hit ALS everything becomes shades of gray, and with the standard of care being dictated by things like the aha and ACLS, protocols tend to turn into more like guidelines.
 
EMT856 said:
Explain how an EMT-B is supposed to field diagnose an AMI? Chest pain and Neuro protocols basically order you to use O2 anyways.
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Acute Coronary Syndrome is a valid clinical diagnosis when additional testing is unavailable or yet to be performed (including serial cardiac enzymes).

The 2010 AHA ECC guidelines pulled back their recommendation for oxygen use for both strokes and ACS since the problem is perfusion (train getting to the station), not an inability to load the train. Also, when the train gets overloaded (hyperoxygenation), bad things tend to happen (free radical damage).
 
EMT856 said:
Studies have been done by those with Medical Degrees, the ones who write the protocols that we all should at least consider, that have shown that prehospital high flow oxygen is not going to cause any ill effects. We do not know in the field what is going on for certain no matter how much we think we do most of the time. Yes, I can think for myself, and If I think there is potential for benefit for the patient, I am willing to try it.
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EMT856 said:
Now lets say protocols say put patient on 02, and you dont. Patient dies anyways, but now you are liable because you didnt follow protocols. My AMS protocol states any pt with AMS gets oxygen.
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I bet you supplied your patient with a minimum FiO2 of 0.21 during your transport.
 
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