To O2 or not to O2

[NomadicMedic]

The idea of giving Hi Flow 02 to every patient is as old as johnny & roy. yet we still beat people over the head with 02 is for everyone LOTS of it too.

As a point of note, Johnny and Roy routinely placed most of their patients on O2 via nasal cannula. Patients with respiratory distress were often given a demand head to "self administer" oxygen. Unconscious trauma patients were given an NRB.

(Yeah, I'm an Emergency™ geek.)

 

[FirstResponderCAD]

The negative effects of short-term oxygen administration in the vast majority of patient populations is virtually non-existent. If there is any noticeable problem with level of consciousness, airway, breathing, or circulatory function, or there is a trauma that can potentially affect ABCs, then the patient is getting oxygen (usually NRB 10-15 L/m). Low Sp02 number is also an indication we use.

NOT EVERY SINGLE PATIENT NEEDS OXYGEN!

 

[Carlos Danger]

It is acceptable as an EMS provider to provide no interventions on the way to the hospital. If something isn't indicated, don't go looking for ways to make it indicated.

Excellent quote. One of those things that seems ridiculously obvious, but which many fail to recognize.

The negative effects of short-term oxygen administration in the vast majority of patient populations is virtually non-existent. If there is any noticeable problem with level of consciousness, airway, breathing, or circulatory function, or there is a trauma that can potentially affect ABCs, then the patient is getting oxygen (usually NRB 10-15 L/m). Low Sp02 number is also an indication we use.

I think this is a reasonable approach. I think it is fair to say "when it doubt, give oxygen".

I'm not saying "lets keep with the EVERYONE GETS AN NRB paradigm", I'm just saying that I'd rather see people get it who don't need it than the other way around. Obviously, many have a tough time decided who does and doesn't really need it, so I think it is safest to err on the side of giving it too frequently.

IMO, the hazards of unnecessary oxygen administration have been drastically overstated on this forum. I'm all for better education on when / when not to use oxygen, but let's not pretend that it's an issue of patient safety, because it really isn't at all. I'm aware of the potential dangers of very high P02's, but in reality, the vast majority of our patients are probably much more likely to be hurt in an ambulance accident on the way to the hospital than by unneeded oxygen.

 

[Christopher]

IMO, the hazards of unnecessary oxygen administration have been drastically overstated on this forum. I'm all for better education on when / when not to use oxygen, but let's not pretend that it's an issue of patient safety, because it really isn't at all. I'm aware of the potential dangers of very high P02's, but in reality, the vast majority of our patients are probably much more likely to be hurt in an ambulance accident on the way to the hospital than by unneeded oxygen.

I see more of the actual hazards for specific patient populations (premies, MI/strokes, intraarrest/post-ROSC, etc) instead interpreted as applying to all patients. An interesting precursor to this are the older overstatements of the hazards of 1.0 FiO2 for COPD'ers.

The obvious solution is to ask that O2 be treated like an actual medication and that doses be appropriate for the patient at hand.

 

[Tigger]

I agree that the dangers of prehospital O2 use are likely over stressed. My issue with it being done inappropriately is more related to EMS becoming something more than a vocation. For that to happen we need to provide treatment for the right reasons and stop committing and accepting obvious medication errors. Even if it is not necessarily detrimental to the patient we still look like a collective bunch of morons when some applies oxygen to say relieve pain and then justifies it with "it's protocol."

 

[unleashedfury]

As a point of note, Johnny and Roy routinely placed most of their patients on O2 via nasal cannula. Patients with respiratory distress were often given a demand head to "self administer" oxygen. Unconscious trauma patients were given an NRB.

(Yeah, I'm an Emergency™ geek.)

lol I can see that. I remember watching some of the shows growing up. I recently added the series to my Netflix que. I actually got my stepdaughter shes 8 watching it and she likes it.

 

[EEEMMMTTT]

Emergency! is a great show... yes it has a !

as an EMT, I like to use oxygen as per protocol. I find that many EMTs strive to learn more and that is fine, but at the end, EMT is just a person that is doing what the doctor orders.

The protocols are in place so we don't have to phone in to Rampart every time we come to a patient for instructions.

because we are technicians, not practitioners, if we think we should do something not in protocol, we are going to have to call Rampart for authorization. And as much they always say to give the patient D5W, we cant automatically do that without permission...

God I love that show...

 

[hobozach]

Well in this case, a "fall Victim" O2 would defiantly be indicated if fall was significant (greater than PTs height). The reason for this is because of a high impact trauma. If I were handling this I would put PT on 15L NRB.

 

[Medic Tim]

Well in this case, a "fall Victim" O2 would defiantly be indicated if fall was significant (greater than PTs height). The reason for this is because of a high impact trauma. If I were handling this I would put PT on 15L NRB.

Is this your protocol or what you would do anyway.
I hope you take the time to do some more research on this topic.

 

[fma08]

Well in this case, a "fall Victim" O2 would defiantly be indicated if fall was significant (greater than PTs height). The reason for this is because of a high impact trauma. If I were handling this I would put PT on 15L NRB.

Why does a fall "defiantly" indicate oxygen?

 

[EEEMMMTTT]

I think it is in the protocols.

 

[hobozach]

Why does a fall "defiantly" indicate oxygen?

Well, depending on fall height and if there are any other injuries. Possible internal bleeding for one, would defiantly be an indication for O2. That's not my protocols that's just how I would handle the situation.

 

[STXmedic]

Well, depending on fall height and if there are any other injuries. Possible internal bleeding for one, would defiantly be an indication for O2. That's not my protocols that's just how I would handle the situation.

So why does a fall make your body less capable of utilizing oxygen, requiring a higher concentration of inspired oxygen?

 

[hobozach]

Well by now I know I am wrong because you are the 3rd paramedic to question why I would put O2 on a fall victim. I was taught that high trauma with possible fractures or internal bleeding should be given O2. I assumed the rational behind this was the lower the volume of blood you have, the less efficient your body is at profusion, and should be put on high flow O2. If I am wrong here please explain why.

 

[VFlutter]

Well by now I know I am wrong because you are the 3rd paramedic to question why I would put O2 on a fall victim. I was taught that high trauma with possible fractures or internal bleeding should be given O2. I assumed the rational behind this was the lower the volume of blood you have, the less efficient your body is at profusion, and should be put on high flow O2. If I am wrong here please explain why.

If they are hypoxic due to anemia then supplemental oxygen will only help to a certain extent. You are somewhat correct in the fact that you want the available hemoglobin to be saturated as much as possible but there is a limit. And oxygen dose not automatically = 15L NRB @ 100% Fi02

 

[ThadeusJ]

Hobozach,

Hemoglobin carries 97% of the oxygen. Only 3% is dissolved. Therefore, if you ain't got the RBC's to carry the oxygen, the oxygen ain't gonna get carried. Even if the RBC's are 100% saturated, if you only have one little cell running around (to be extreme in this example), you still have very low oxygen delivery. You have to use hyperbarics to dissolve enough oxygen in the plasma to keep a system alive.

For those who need an analogy, I always compared oxygen delivery to trucking: the lungs are the loading docks, the RBC's are the trucks, the arteries are the roads and cells are the customers. Normally the trucks are packed at 92-96% capacity. You can pack them higher if you want, but 100% is 100%. If you have less trucks, they are still packed to 100%, but you will still have less arriving to deliver the goods. That's why if yo infuse litre upon litre of fluids into a bleeding patient, you may still have good SpO2 levels, but lousy carrying capacity.

COPD issues deal with problems on the loading dock...you get the idea.

 

[FiremanMike]

Hyperoxia is shown to have an INCREASED mortality rate in patient populations including post cardiac arrest, myocardial infarction, stroke, and others. From the oxygen-hemoglobin dissociation curve, we know that SpO2 of 90-99% is pretty close to actual blood oxygen levels. Once SpO2 reaches 100%, we frankly have no earthly idea what blood oxygen levels are. They could be 100mmHg, they could be 650mmHg, we just don't know.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218982/


99% is the new 100%..

 

[Aprz]

99% is the new 100%..

Ooo... I like that. *steal*

 

[NomadicMedic]

Actually, anything >95% is the new 100%.

 

[VFlutter]

Once SpO2 reaches 100%, we frankly have no earthly idea what blood oxygen levels are. They could be 100mmHg, they could be 650mmHg, we just don't know.
.

Arterial Pa02....

Actually, anything >95% is the new 100%.

+1, I would even say anything >93% is the new 100%