- 4,997
- 1,389
- 113
So, what did you learn today?
- Thread starter liftwithlegs
- Start date
MIkePrekopa
Forum Crew Member
- 66
- 0
- 0
that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask.
looking forward to the part where we shove tubes into dummies 
looking forward to the part where we shove tubes into dummies 
daedalus
Forum Deputy Chief
- 1,784
- 1
- 0
that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask.
I wish they would stop teaching EMT students this silliness.
Shishkabob
Forum Chief
- 8,264
- 32
- 48
COPD.
Oxygen toxicity.
Oxygen toxicity.
- 4,997
- 1,389
- 113
COPD and Oxygen Toxicity... mostly myth, but you can shut down their respiratory drive if they truly have stopped responding to CO2 levels... and are on oxygen drive.
- 4,997
- 1,389
- 113
that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask.
Agreed. What about 25LPM by cannula???
Shishkabob
Forum Chief
- 8,264
- 32
- 48
Just because it isn't likely does make it any less...err... ignorant... to give everyone 15/6 without actually assessing.
Ridryder911
EMS Guru
- 5,923
- 40
- 48
that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask.
Too bad the curriculum and the criteria they are teaching from does not educate you properly to respect or on the proper administration of oxygen therapy. More shameful, it is doubtful that your instructors actually have a grasp on even the basic concept of oxygen therapy.
The "shoving tube" philosophy is just immaturity. When in fact a true educated provider would attempt by all measures to have to prevent and reduce the occurrence of these procedures have to occur. Knowing and recognizing there are times these procedures are needed but as well recognizing the extreme associated dangers associated with them as well.
I would like for you to ask your instructor some basics of the oxyhemoglobin ratio or even more simplistic oxygen ventilation ratio.
As more time progresses we are recognizing that oxygen is a medication and that administrating is not as benign as once was thought. It alike any other medication has side effects and dangers associated with it. Unfortunately, the old standards are being taught and re-enforced so along with this comes bad patient care.
Glad for your enthusiasm but dig a little deeper you will find providing emergency medical care is not as simplistic or black & white as it appears. You will question more and more of treatment being taught and will become more informed.
Good luck,
R/r 911
Last edited by a moderator:
Originally Posted by MIkePrekopa
that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask.
Does anyone believe 6 L/M NC and 15 L/M NRBM are equivalent to each other? Did anyone hear of FiO2, Minute Volume, Tidal Volume, dilution, air entrainment or purpose of each delivery device? How about just the purpose of providing O2 to a patient? Did any instructor discuss "why" this is done other than just its in the protocol? Does anyone know why some medical directors must write their protocols as they do?
Agreed. What about 25LPM by cannula???
If you work in a hospital, you'll see up to 40 L/M NC. Even on a neonate you might see 8 L/m by NC. However, we do use a very good humidification system. If you study relative and absolute humidity, you will understand why this is possible. No, you can not use one of those little humidifiers you see everywhere attached to NCs in the hospitals for this purpose and in reality those do not serve much purpose.
Not eactly myth because there are reasons medical reasons for why this was thought for years. However, they now find it is not the "hypoxic drive" that initiates the responses. As well, you have to differentiate the different types of COPD and each has its own process that requires a different plan of treatment.
Oxygen Toxicity is a serious issue but it is rarely a concern for EMS who is only with the patient for a few minutes. It is a concern for hospital personnel who work with ventilator patients as the clock starts ticking until we can get patient belows 60% O2 at least. I few more comfortable when they are at 50% or less. However, certain disease processes require higher FiO2 so the risks and benefits are examined. If the patient is on a sepsis protocol and the SvO2 levels are being monitored, we will run the FiO2 higher until the SvO2 is stabilized and/or the lactate levels are below 4 mmol/L or at least trending in the right direction. Again, EMS will not need to be concerned for this in the short term.
Last edited by a moderator:
PapaBear434
Forum Asst. Chief
- 619
- 0
- 0
that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask.
I realize that everyone has probably already nailed you on this, and I don't want to stack on, but not EVERYONE will benefit from O2. In fact, some people can actually be hurt by it.
Follow what your instructors say for now, so you can pass the class. But when you get to the street, remember that you have to treat every patient individually and O2 isn't necessarily the first thing you should reach for.
My paramedic partner on wednesday explained to me that the trendelenburg actually can cause more harm than good be cause it fills the bessors (SP?) glands so the body has a false idea of its blood volume and slows down its heart.
Any one have any studies on this? JEMS only provided a small amount of information on it.
Any one have any studies on this? JEMS only provided a small amount of information on it.
Shishkabob
Forum Chief
- 8,264
- 32
- 48
I'm going to assume your partner said Baroreceptor. These are sensors located in the blood vessels (aortic arch and carotid are the only ones I remember) that help in the negative feedback of blood pressure. When pressure drops and they sense it, they increase periph. resistance and increase cardiac output.
Trendelenberg only sages what, 250ml of blood volume? And that's before they get decompensated.
Trendelenberg only sages what, 250ml of blood volume? And that's before they get decompensated.
This is why some college level A&P can be very helpful.
You probably found this article.
http://www.jems.com/news_and_articles/columns/Wesley/the_myth_of_the_trendelenburg_position.html
Whenever reading something in a fluff mag like JEMS, always look up the original article they are reviewing or the references at the end of the article.
http://www.cjem-online.ca/v6/n1/p48
- 4,997
- 1,389
- 113
What I got out of reading the article (that JEMS reviewed) is that the Trendelenburg position might cause more issues than it resolves. In any event, another thing that stuck out to me was that in healthy subjects, Trendelenburg increases LV filling, stroke volume, and therefore Cardiac output... but also that the effect is transient. In hypotensive patients, there probably isn't enough "fluid in the tank" so to speak to show any positive changes, and since it can put pressure on the diaphragm, you could very well see a decrease in CO. Which to me says, if your patient is in shock, IF you use it, use it briefly... long enough to get a line and begin volume replacement... and by extension, once you're doing that, return the patient to a flat position.
Another way to think about this is: if the MAST doesn't work, Trendelenburg probably won't work well either. You're attempting to autotransfuse the central circulation... one method uses external pressure... the other uses gravity.
Another way to think about this is: if the MAST doesn't work, Trendelenburg probably won't work well either. You're attempting to autotransfuse the central circulation... one method uses external pressure... the other uses gravity.
Shishkabob
Forum Chief
- 8,264
- 32
- 48
Who said MAST pants don't work?
PapaBear434
Forum Asst. Chief
- 619
- 0
- 0
I learned that lesson by watching a nursing student push it behind curtain #2 while I was standing in front of #1, waiting to turn over a patient.
I am VERY glad I was standing in front of #1, rather than #2.
Ridryder911
EMS Guru
- 5,923
- 40
- 48
There are numerous studies that have proven that PASG are not as effective as one once thought. That is if application was that as the current procedure & application was followed at that time.
Studies does not prove that they do not work, rather they have no increase in outcome survivability. The same could be placed on other various treatments we now perform routinely.
New research is demonstrating that it does increase TPR to a small degree, but with this also comes the harmful side effect of lactic acidosis. I do believe we will see PASG return on specific injuries and conditions with a new different application and inflation procedures. As just part of the treatment of shock and definitely recognizing it is only aiding in treatment but it maybe a while as it was slammed very hard in the early 90's.
R/r 911
Shishkabob
Forum Chief
- 8,264
- 32
- 48
I was leaning more towards the usage of bilateral femur fractures.
The 'off-the-label' usage.
The 'off-the-label' usage.