usafmedic45
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Go do some research on the actual epidemiology of RoP and report back.
Too Much Oxygen? hmmmm
- Thread starter HeadNurseRN
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Go do some research on the actual epidemiology of RoP and report back.
ihalterman
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Our new standard is no O2 for SPo2 >94% unless they complain of SOB. O2 is a vasoconstrictor, that's a bad thing in an MI.
JPINFV
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Yep... let's get rid of all tools while we're at it, starting with cardiac monitors. After all, an atypical MI presentation is probably just a machine error, right?
I guess we should keep them, if you can not walk into a room and see an ashen grey patient grabbing their chest short of breath and dripping in sweat. And you hold your judgment of what is going on until you actually hook up your monitor. Well yeah I guess you need that 12 lead. I guess if you get a perfect 12 lead and the patient still looks crappy you are not worried? Treat the patient not the monitor, or you know what the word assume means right?
Tools are only what the word means a tool to help you in your clinical judgment, still falls back on your training.
Now wanna refute that?
Sorry, I did not mean to jump your ***. but until you learn the difference between compensated and uncompensated distress and know the values of oxy-hemoglobin curves then you will not understand the effects of resp distress on a patient. Your point is valid on non typical acute cardiac patient, but a perfectly normal EKG does not rule out anything.
JPINFV
Gadfly
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So... all of your MIs present like this?
You should start using your clinical judgment to determine potential causes as soon as you see the patient. You don't shut down just because you got a specific reading or specific exam finding, regardless of what they are, or what tools, be it your eyes or your monitor, says.
I'm not the one trying to argue that we shouldn't use tools. I've maintained throughout this entire thread that tools should be incorporated into an assessment, not ignored just because a presentation doesn't match it completely. A monitor or pulse ox or blood glucose monitor are a tool, just like our senses. No one part of the assessment should be used to the mutual exclusion of all else, be it a tool or a sense. After all, would you ignore a STEMI because the 65 y/o diabetic female is complaining of abdominal pain and not chest pain?
JPINFV
Gadfly
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It rules a lot of things out. Show me a 3rd degree AV block with a normal EKG. However, I think you're thinking something along the lines of STEMI vs NSTEMI, in which case show me where I said a normal 12 lead ruled out NSTEMI.
Actually lets just agree to disagree okay. Because by definition a STEMI is an ST elevated MI. But a normal 12 lead does not rule out an MI, but it does rule out a STEMI. There are more than one MI's and the treatment rules dictate various approaches, such as sub endocardial just to name one. Treatment of choice for a STEMI is PCI. Others have different treatment algorithms, but then I digress from the original topic. I will still fall back on the rule, if you need tools as the for-mentioned pulse ox then use it. I just hope that when you see a patient that is gasping for breath and Cyanosis your fist move is to grab the pulse ox.
Um, just for the record. Isn't that what I said in the first place? And you took issue at it, LOL
As so stated?
like that part?
JPINFV
Gadfly
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Hmm, learn something new... oh, wait.
Actually, looks like I covered non-STEMIs there...
Do you want to know how I know you haven't read this thread?
JPINFV
Gadfly
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I take issue with the cliche "treat the patient not the monitor" because you should be treating the patient and the monitor and asking, "why?" if the two aren't correlating as you would expect they are.
It is good your take issue with it, so honestly as a clinician what would you believe?
Your own clinical judgment or that machine? that is all I stated, and yet you got all pissy?
Tell me?
It all started with Oxyhemoglobin Dissociation Curve theories and my judgment on those. I apologize, I am sorry. But I just wanted to convey that a absolute good PSO2 does not correspond to tissue profusion. The topic got twisted to MI's which was way off topic. But I am good with that too.
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JPINFV
Gadfly
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A tool does not provide clinical judgment. Clinical judgement is the integration of all available information, be that sensory input (what do we hear (including the history), feel, smell, see) or assessment tools. It's just as foolhardy to assume that a tool is wrong for no reason than it's not reading what I'm expecting it to as to ignore signs and symptoms because it's not what I'm expecting. What if what I think is happening is wrong, hence what the information from a history and physical (including appropriate diagnostic tools) not correlating with what I'm expecting?
As I mentioned earlier in this thread, I need something more than paranoia or wishful thinking to assume that a tool is wrong just because it's not matching perfectly. Yes, the physical exam findings could be misinterpreted. So when things aren't matching as expected, you have to consider that the exam findings were wrong (Did the patient misunderstand or make a mistake during the history? Did I really find ___ on my exam?), the tool is wrong (trouble shoot the tool), or the working and differential diagnoses needs to be reconsidered. Is a differential Dx now more likely than the working Dx? Does something else need to be added?
If a tool is going to be ignored if it's readings don't match what it is expected to be, why even use the tool?