Respiratory emergency question

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redbull

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If a patient has a normal respiratory rate and pulse but is CYANOTIC, would you give him positive pressure ventilation with supplemental oxygen or a nonrebreather mask via 15 lpm?
 
i would do a NRB unless his RR is 8 or under or extremely fast.
 
No, what does objective clinical evidence tell us? Does he have signs of hypoxaemia?

If so, then yes, he would recieve supplumental oxygen; if not, then no

SPO is an adjunct to a good thorough assessment and not a replacement
 
It would probably totally depend on the patient's underlying condition. If the patient is hypoxic with a normal respiratory rate and pulse that indicates that the patient's compensatory mechanisms are not working properly. I want to know why.
 
Didn't say hypoxic, just cyanotic in CAPS on the quiz. I went back to the Brady text and i figured since the patient has normal breathing and pulse then it's a non-rebreather. But the Cyanotic part threw me off.
 
When looking at a patient and determining if they are getting enough oxygen you have to look at more than just the respiratory rate.

Think minute volume which is the amount of air in and out in a minute (very important). Respiratory rate is just one part of minute volume... the other part is tidal volume which is assessed in the field by looking at the depth of respiration. If they are breathing at 20min but very shallow than their tidal volume is decreased and they may not be ventilating with a minute volume high enough to meet the body's demands.

If a patient is cyanotic, than they are also hypoxic for whatever reason.

To answer your question based on what info was provided... I would try a NRB at 15lpm and if no improvement quickly I would start positive-pressure ventilation. Since the patient has spontaneous resp at a normal rate, you would want to do overdrive ventilation..
 
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As this is in the BLS section I'll assume the question is out of your BLS textbook.

The answer is 15lpm. NRB. In the DOT curriculum you are looking for less than 8 or greater than 24 respiratory rate for BVM.

(Yes everybody I know how much more to the decision to use PPV there is. And yes, I understand there is much more to discuss about the pt condition in this example, however if this is a question out of the EMT textbook, the answer is 15lpm. NRB, that's all I'm sayin')
 
redbull said:
Didn't say hypoxic, just cyanotic in CAPS on the quiz.
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Cyanosis is a sign of hypoxia. Either that, or your patient is a smurf. ^_^
 
How's my SAT? How's their effort of breathing and LOC/LOA? What are the rest of the vitals in context, are they the text book HR of 72 or their normal resting HR? A HR of 60, with a RR of 12 in an person w/ decreased LOA may be pre-arrest if they've been in severe repsiratory distress so far and are no longer able to compensate. What's my ETCO2 show?

Depending on the entire clinical picture we may be looking at NRB, BVM or CPAP.
 
sdadam said:
As this is in the BLS section I'll assume the question is out of your BLS textbook.

The answer is 15lpm. NRB. In the DOT curriculum you are looking for less than 8 or greater than 24 respiratory rate for BVM.

(Yes everybody I know how much more to the decision to use PPV there is. And yes, I understand there is much more to discuss about the pt condition in this example, however if this is a question out of the EMT textbook, the answer is 15lpm. NRB, that's all I'm sayin')
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Are you my instructor? :)
 
Who knows!

What school are you attending, I just might be. ;-)
 
I asked a question similar to this in class, and was told that it was dependant upon their level of conciousness. If they are sitting up, concious albeit freaked out b/c they are in respiratory distress, good luck getting them to lie down to be bagged. They get a nrb. Unconcious or barely concious, laying down, bvm.
 
I say CPAP...or just intubate them all.. and ask questions later!
 
FLEMTP said:
I say.. just intubate them all.. and ask questions later!
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Now now mate, that thinking might just land you a job as a helicopter doctor! :D

I misread that in the first instance, if the patient is cyanosed and showing sings of hypoxameia then I would provide some supplumental oxygen.

Am I going to cram 15 litres down thier throat? No, simply because if thier FiO2 is normal then what good is massively increasing the amount of oxygen they are getting?

My guess is that thier SvO2 is not high enough which points to some sort of oxygenation problem rather than a ventialory issue. Oyxgenation and ventilation are not the same thing.

And as for that ABG um .... who took my iStat machine? :D

Oh, um ... and how do you read an ABG? Maybe knowing that is important hmm ...
 
redbull said:
If a patient has a normal respiratory rate and pulse but is CYANOTIC, would you give him positive pressure ventilation with supplemental oxygen or a nonrebreather mask via 15 lpm?
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depends on the pt - why are they cyanotic? are you sure it is hypoxic cyanosis? (IOW, were they swimming in cool water for the last half hr and just cold?) pt by pt, medical hx as a factor, on the street i would go supplemental O2 via NC or NRB; i would consider BVM for an unresponsive or severely AMS pt. would also want to know depth of resps - if the pt is breathing normally but esp shallow that could be contributing. on a test, as a test question, with no other information, i would give NRB @15lpm.

WolfmanHarris said:
How's my SAT?
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i hate pulse ox. treat the pt not the machine/monitor/numbers. pulse oximetry is not a reliable tool....
 
PrincessAnika said:
i hate pulse ox. treat the pt not the machine/monitor/numbers. pulse oximetry is not a reliable tool....
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Horse hockey. A good piece of advice on avoiding tunnel vision has become this weird pseudo-luddite mantra. A thorough understanding of your equipment, it's limitations and how it works tells you a great deal about the patient's condition, that cannot be gained through physical and history alone.

Pulmonary embolism are extremely atypical in their clinical presentation, but a 12 lead may detect it. (S1Q3T3 pattern)

An otherwise healthy young person may present with fairly classic ischemic CP w/o any Hx of drug use. Without a 12 lead you may not Dx percarditis. (Global ST elevation)

A simple lift assist of an extremely elderly person may get signed off, but a simple SPO2 clues you in to the underlying hypoxia as the cause of the weakness and you decide to transport despite no other significant clinical signs. Remember the elderly do not always present with clear S&S.

ETCO2 waveform can detect bronchospasm and the progress of it's resolution with treatment.

I could go on.

The fact is modern medicine relies on diagnostic equipment and labs as important tools in diagnosis and treatment plans. We need to embrace our equipment and it's limitations as important in forming proper, full assessments and treatment plans.
 
MrBrown said:
And as for that ABG um .... who took my iStat machine? :D
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I'm looking forward to the day in my career when we start doing on scene cardiac markers. Maybe even lactate for sepsis screening (is that 85 y/o generally unwell a failure to thrive or are they septic? Can they wait hours or be offloaded into subacute, or do they need aggressive treatment?)
 
PrincessAnika said:
i hate pulse ox. treat the pt not the machine/monitor/numbers. pulse oximetry is not a reliable tool....
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Actually, pulse ox is a VERY reliable tool, so long as you know how to interpret it and understand to not take it at face value.
 
Linuss said:
Actually, pulse ox is a VERY reliable tool, so long as you know how to interpret it and understand to not take it at face value.
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IF. that's a really big IF. far too many people (in and out of hospital) look at the pulse ox and numbers, and fail to provide pts with proper care, bc "the number is 'normal' " - example of this is the pt my husband had 2 wks ago - older fm, resp distress, tripoding, normal color, etc... 98% RA. nurse in ER wants to know why pt is on oxygen "bc her sats are normal" - keep in mind pt is still tripoding....
yes, used properly, it can be great, but used at the expense of proper pt care....
 
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