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I swear there is a class in RN school on how to be an a$$hole to EMS.
Jon
Jon
"That BP is NOT possible"
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I just love arguing with nurses on that one.
"You can't give 15lpm O2 to a COPD patient."
"Wanna bet?"
"You can kill them."
"Not in the relatively short time I have contact with them. Besides, if they code, we have to give them 15lpm while we're bagging them. If you don't like it, contact my medical director and tell him you said he needs to change our protocols for COPD patients."
Never had one take me up on that yet.
"You can't give 15lpm O2 to a COPD patient."
"Wanna bet?"
"You can kill them."
"Not in the relatively short time I have contact with them. Besides, if they code, we have to give them 15lpm while we're bagging them. If you don't like it, contact my medical director and tell him you said he needs to change our protocols for COPD patients."
Never had one take me up on that yet.
usafmedic45
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This is my first post here, and I feel I should state my qualification to make a comment here (I'm a respiratory therapist in addition to being an EMT-I).
The nurse is kind of right- under normal circumstances (stable patient) you can give too much O2 to a COPD'er, specifically those who are functioning off their hypoxia as a stimulus to breath (what's called hypoxic drive). Simply put, you will knock out their signal to breath if you raise the SP02 too high.
However- in an emergency, there is no such thing as too much O2....at least in the sense that it's better to give them the O2 and maybe have to bag them than for them to suffer deleterious effects of insufficient O2.
And remember that in a COPDer, their normal SPO2 may be 88-90% on several liters of O2. Quite a few function (relatively speaking) with SpO2's in the low 80's or even high 70's as their norm.
Of course, there is a whole lot more that goes into this topic than just this, but I won't bore you with that info. If anyone wants to know anythign further, please just ask.
BUT FOLLOW YOUR LOCAL PROTOCOLS (Just so you don't get in trouble
)
The nurse is kind of right- under normal circumstances (stable patient) you can give too much O2 to a COPD'er, specifically those who are functioning off their hypoxia as a stimulus to breath (what's called hypoxic drive). Simply put, you will knock out their signal to breath if you raise the SP02 too high.
However- in an emergency, there is no such thing as too much O2....at least in the sense that it's better to give them the O2 and maybe have to bag them than for them to suffer deleterious effects of insufficient O2.
And remember that in a COPDer, their normal SPO2 may be 88-90% on several liters of O2. Quite a few function (relatively speaking) with SpO2's in the low 80's or even high 70's as their norm.
Of course, there is a whole lot more that goes into this topic than just this, but I won't bore you with that info. If anyone wants to know anythign further, please just ask.
BUT FOLLOW YOUR LOCAL PROTOCOLS (Just so you don't get in trouble
)BloodNGlory02
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I often wonder why we have so many CEU's and refreshers to attend, and nurses only have to renew ACLS and CPR. oh wait.. thats because they have a doctor on their @ss all over the hospital. They rarely have to think for themselves. *No offense*
Firechic
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Jon, I'm taking my last nursing class and I never saw that particular class in my curriculum! They must learn that AFTER RN school!
I once thought the same way you do, but actually going through RN school has changed my point of view. Some states, not all, mandate RNs to fulfill CEU requirements in order to renew their certifications. If not mandated by state law, then their place of employment requires certain CEUs.
Nurses do think - they are a patient's advocate, just like we are in the field.
I've met plenty of a** nurses and plenty of a** medics. Lumping them all together is really not a fair statement.
CodeSurfer
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As with any profession there will be the a$$es and the cool ones (like me) but you just deal with it and move on. If you do everything you are supposed to do it's their a$$ on the line, not yours. Not saying I dont care if they are making decisions not in the patients best interest but getting all bent out of shape about it isnt going to solve it. We do our job and they do theirs. When they dont do theirs we can report them, just like if we didnt do ours someone would report us.
Am I way too "go with the flow"? I swear it's what keeps me alive.
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Steve, my lead medic class instructor is a Resp. Therapist and Paramedic.Originally posted by usafmedic45@Apr 17 2005, 06:13 PM
This is my first post here, and I feel I should state my qualification to make a comment here (I'm a respiratory therapist in addition to being an EMT-I).
The nurse is kind of right- under normal circumstances (stable patient) you can give too much O2 to a COPD'er, specifically those who are functioning off their hypoxia as a stimulus to breath (what's called hypoxic drive). Simply put, you will knock out their signal to breath if you raise the SP02 too high.
However- in an emergency, there is no such thing as too much O2....at least in the sense that it's better to give them the O2 and maybe have to bag them than for them to suffer deleterious effects of insufficient O2.
And remember that in a COPDer, their normal SPO2 may be 88-90% on several liters of O2. Quite a few function (relatively speaking) with SpO2's in the low 80's or even high 70's as their norm.
Of course, there is a whole lot more that goes into this topic than just this, but I won't bore you with that info. If anyone wants to know anythign further, please just ask.
BUT FOLLOW YOUR LOCAL PROTOCOLS (Just so you don't get in trouble
Fun to hear him give this lecture.
If my patient is in respritory distress, I give them oxygen.
My favriote was the patient who the nursing home got in at 3pm, and sent out at 4:30pm for "low pulse ox" Pt. satting at 78-79% RA, then 86-88% on 4lpm. Pt is without cyanosis or any respiratory distress. If fact, pt. has no complaints at all.
Pt. transported to ED... ED staff looked at me like I had three heads saying that pt. must be cyanotic with that SpO2. Would have been nice to see the blood gasses.
Jon
Margaritaville
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USAFmedic45,
Let me give you my qualifications - I am a senior paramedic with 9 years career (21 years volunteer), and hold an A.A.S. degree.
I am not sure if you are aware and please don't take this as to being rude, but where I ride the information concerning COPD patients and hypoxic drive is taught at the very basic level. Not only do we give O2, but we know why we are doing it!
The point that was being made in this post was that yet again, a nurse was attempting to point out what an EMS provider did wrong in his/her opinion. According to my protocols, I answer only to the Dr. at Medical control - not the nurse on the radio or in the ED. God bless our nurses for the job that they do, but if they will stay out of our sandbox, then we'll stay out of thiers!
Any questions about that, please feel free to ask and I'll be happy to explain!
Let me give you my qualifications - I am a senior paramedic with 9 years career (21 years volunteer), and hold an A.A.S. degree.
I am not sure if you are aware and please don't take this as to being rude, but where I ride the information concerning COPD patients and hypoxic drive is taught at the very basic level. Not only do we give O2, but we know why we are doing it!
The point that was being made in this post was that yet again, a nurse was attempting to point out what an EMS provider did wrong in his/her opinion. According to my protocols, I answer only to the Dr. at Medical control - not the nurse on the radio or in the ED. God bless our nurses for the job that they do, but if they will stay out of our sandbox, then we'll stay out of thiers!
Any questions about that, please feel free to ask and I'll be happy to explain!
rescuecpt
Community Leader Emeritus
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Just like I didn't question the nurse tonight who unwrapped my bandaging on a head lac that took me 20 minutes to get under control... then she was surprised when the patient started gushing blood again... all I said was "huh... must be a bleeder".
LOL!!! :lol:
Summit
Critical Crazy
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I had a pt that was satting at 69% on the monitor (the transferring clinic didn't have her on O2, no order for O2) and looked terrrrible. A little O2 and she looked muuuuuch better back in the 90s and said she felt much better. No history of COPD. I told the receiving RN about this. I went off to the ED EMS lounge to write my report. I forgot to get a pt signature on the HIPPA form so I went back to the Pt. The RN had removed her from O2, she was now @ 82% (lower altitude) and looked like crap again. I mentioned this to the nurse as I handed her my report. "Oh, she'll be fine." <_<
Wingnut
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Why??? Why do they do that???
man I wouldnt sweat it...and no offense to any decent nurses reading the posts, but just cause they have RN after their names, doesnt meant hey are the authority on pt care. Ive seen BPs as high as +300 systolic with the pt bleeding from every orifice, and Ive seen nurses doing chest compressions while the patient was screaming at them to stop because it hurt. People are still stupid regardless of their credentials...
Dont let the red tape get you down...
Dont let the red tape get you down...
You are soooo right about that...I have also seen some stuff and it amazes me that these people are still certified to treat people..Actually it's scarey...I see it everyday in the nursing home where i work..We had a resident in respiratory failure and i walked into the room to see if i could help and there i see a RN trying to sunction the PT with a oxyen tube while the LPN is putting a nebulizer mask on the resident instead of a non rebreather....They looked at me and asked for me to help them...Have you to know that i'm a recreation therapist and i ended up doing the care, plus having to speak to the doctor about the treatment that was giving to the pt...I'm sure not all RN'S and LPN'S are like that but it still amazes me today how some of these people got a license to care for people.. :blink:
rescuecpt
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emt3225 - you don't work at Gurwin, do you???
rescuecpt
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Yes, I am going to Heidi's firematic services tonight, then I think as a group we might head over to the end of Bill's wake. I'm riding tomorrow so I can't go to his prayer service.
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How's Alex doing?
rescuecpt
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He sounds ok, I've talked to him everyday - we are over 1hrs drive apart so I haven't seen him yet - but I will see him tonight. I know he's going crazy right now, but he's putting up a pretty good front. I can't wait to see him tonight and give him a huge hug.
Thanks for asking, I know he appreciates the concern.