Shortness of breath question

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Dillon Baker

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We were called to a residence for shortness of breath. We did our assessment and began transporting, vitals normal o2 sat was 97% so I wasn't concerned. I put pt on o2 via nasal cannula @5 lpm and took her to the hospital. Upon arrival to the er the nurse came in and I gave my report, then she looked at me weird and immediately took the pt off our o2, I didn't ask why I just got my signature and left. I'm still somewhat new to the field and I'm just wondering if I made a bad decision with the oxygen, I thought it was bls protocol to treat shortness of breath with o2, am I wrong?
 
Most providers don't flinch at a pulse ox of 97. BLS with a complaint of shortness of breath, sure throuh some O2 on if your protocols say so, but 5L is a little much. 1L would be fine.

As a new EMT, heck even as an old EMT, don't be afraid to ask questions. Maybe the nurse was just getting a room air sat, but a simple "I'm new at this, do you thithinxygen was indicated?" will do.
 
O2 sat of 97 is great. If there's no symptoms of SOB, there's no real reason to give O2. To use the old phrase, treat the patient not the machine/call/complaint. Also, 5L through a cannula is a lot. It feels like someone blowing up your nose with a straw. It's a good idea to try it on sometimes to get an idea of how it feels. I find anything over 3lpm through a cannula is pretty uncomfortable. But I may just have a sissy nose...
 
Was the patient actually showing signs of respiratory compromise?
 
As some other people already stated why give the patient supplemental O2 if they have normal vital signs and a SpO2 of 97%?
 
Dillon Baker said:
We were called to a residence for shortness of breath. We did our assessment and began transporting, vitals normal o2 sat was 97% so I wasn't concerned. I put pt on o2 via nasal cannula @5 lpm and took her to the hospital.
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Room air SpO2 of 97% absent other signs of respiratory distress doesn't necessitate/suggest a need for oxygen administration. However, rarely is BLS oxygen administration in the EMS setting likely to cause harm (¿non?). NYS protocols would have encouraged 15 lpm via NRB, which is ridiculous. CT protocols would encourage the same. Common sense and good judgement suggest otherwise: no oxygen would likely be OK, and a nasal cannula at 2lpm would be more than enough.

Would I have administered oxygen? No, probably not, as it doesn't appear to be clinically indicated based on the presentation as described. Is it wrong (i.e. breaking from the standard of care or otherwise) to administer oxygen as the OP has described? No, I sincerely doubt it.

OP, you did nothing *wrong*, but next time, consider being more judicious in your administration of oxygen.
 
^Love this reply. I felt like my "like" alone wasn't enough to express my agreement.
 
chaz90 said:
^Love this reply. I felt like my "like" alone wasn't enough to express my agreement.
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Obrigado!

(Caveat: I don't actually speak/write/read Portuguese)
 
Short answer, no, you didn't do anything wrong, you're not going to do much harm to someone by giving them oxygen, even at 5LPM! As has been hounded above, there was no real need to give O2 based on what we heard. Sure, you can give O2 as a comfort measure, but unless the pt asked, I wouldn't have worried about it.

As to why the nurse freaked out, who knows, should have asked, may she saw a ghost, you never know, I can't think of any reason.
 
avdrummerboy said:
As to why the nurse freaked out, who knows, should have asked, may she saw a ghost, you never know, I can't think of any reason.
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Just to add to this. As mentioned above, it could very well be in order to obtain a sat on room air. If the patient isn't in severe respiratory distress, we will hold oxygen for a little while just to get that room air sat as a baseline, then put them on oxygen, generally starting at 2L and advancing as necessary.

Some nurses unfortunately still cringe at the thought of COPD patients receiving any high concentration oxygen, perhaps he/she made an assumption.
 
Was the patient actually having shortness of breath or is that just what you were dispatched for? I wouldn't let the nurse bother you too much. Sometimes they like to get a room air sat. Would I have put this patient on O2? Prob not based on what is reported.

Just remember that oxygen is not a cure all and is a drug that can harm as much as it can help.
 
avdrummerboy said:
Short answer, no, you didn't do anything wrong, you're not going to do much harm to someone by giving them oxygen, even at 5LPM! As has been hounded above, there was no real need to give O2 based on what we heard. Sure, you can give O2 as a comfort measure, but unless the pt asked, I wouldn't have worried about it.

As to why the nurse freaked out, who knows, should have asked, may she saw a ghost, you never know, I can't think of any reason.
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That is not an indication for O2 administration. Nor is it comfortable.
 
without actually seeing your patient, it is hard to say if I would have put the patient on oxygen or not, also without knowing the patients history, it also makes it a little difficult. But if my patient is not having any signs or symptoms of resp distress/SOB, I probably would not have put the pt on oxygen. Now if the patient is complaining of SOB, and most likely would be hyperventilating, I would but a NC on at 2 or 3 and coach her breathing down, but once again without actually seeing, it is hard for any of us to say what we would or wouldn't have done.

Now I do not see anything wrong with what you have done by applying oxygen and transporting.
 
maybe the nurse freaked out because you were flowing a cannula @ 5lp...who knows :confused:
 
Where did the nurse "freaking out" come from? I read it as she had a puzzled look and removed the O2...that's far from freaking out.

Others have said it but unless there where signs/symptoms of respiratory compromise I wouldn't have put this patient on oxygen. It's pretty rare I put people on more than 2lpm via a cannula unless they're on a higher flow rate on their home O2.
 
Tigger said:
That is not an indication for O2 administration. Nor is it comfortable.
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Somewhat disagree. O2 can indeed be a comfort measure in some isolated settings. Anecdotally, I find it helps with nausea, and in the 8-10 percent of patients with new ticagrelor prescriptions that experience a profound sensation of dyspnea, oxygen is a massive comfort measure.
 
I don't have any sources other than things my instructors have said in class (which I completed recently) so take all this with a grain of salt:

What I've been told is that the movement is towards not giving O2 unless SPo2 < 94%. O2 is essentially a drug and as a BLS community, it's been overused. There is little indication that it does the patient any good if they are above 94% SPo2, and o2 toxicity is a possibility (especially on a long transport).

On a side note, after having thrown a cannula on myself and cranked it up to 6lpm, I won't go over 4lpm on a patient with a cannula. I find it uncomfortable unless it's humidified, and then it's going to be a mask anyways. I'll go to an NRB instead; that's personal preference though.
 
Always treat the patient not the monitor: If they say they are having problems breathing and are showing signs of it, treat them for it.
When I am breathing normally I have a SPO2 of about 90-93%; when my asthma is acting up and I am have a rough time breathing it is usually 96-98% (last time I was breathing 60 times a minute and had stopped wheezing just after due to not moving enough air {SPO2 then dropped into the 80's%}): strange I know, but a co worker told me it is probably because I am working so hard to breathe that I am moving more O2 to the extremities than normal; as long as I am compensating I do better, when I start to crash I crash hard and drop low (68% in the ED one day just before I was admitted for 4 days).
 
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