VentMedic

What is with you and nurses? YOU mentioned some comment from an anonymous poster from over two years ago and YOU mentioned articles that were all opinion but tried to present them as facts. I also have a little more interest vested in this artilce than just living in the U.S. or Florida as you relate to your anonymous friend living in Canada. A drunken conversation is your evidence for argument? Now you are wasting my time. YOU brought up the Canadian studies. The article was a study from a trauma center. You presented some article about cardiac arrests in Canada that was also done as part of the OPALS. I simply wanted you to compare trauma to trauma. Also, as I have already mentioned, you can not equally compare Canadian "BLS" with the American 120 hour EMT-B. I bet you don't know who funded this study. Could care less about Herbie. If you read other journals you will find studies that have been done for flight RNs and RRTs intubating in the field. Air Med had ran a couple of articles. Paramedics are not the only ones that do transport and scene response. There are PHRNs as well. Do some reading. And what do a GP in a small rural hospital missing a tube have to do with Paramedics intubating? Enough with the "he can't intubate either crap". That is not a valid excuse for why a Paramedic can't intubate since they are supposed to be trained in that skill whereas a GP is NOT. To compare a job that you are specifically trained to someone who has very little to no training in is just stupid. It is a sad statement that these hospitals do have to resort to using GPs as a substitute for an ED doctor. As far as the BLS, I seriously hope you don't think 120 hours of first-aid training is adequate. Do you not even understand why there is a concern with that? The discussion was about concerns in the U.S. since it stemmed from an article in the U.S. If you had read the whole article and not just the abstract you would have known this article is about Paramedics from Miami-Dade specifically who work for a FD. Some of the delicate egos here have taken this study about one FD very personally. I have tried to tell you where, how and why this study was done which you would also have known if you read the whole article. You don't work in the U.S. You probably haven't even been following the changes that will hopefully start to happen. If people carry on as if there is not problem, how can anyone or any system improve? If you can intubate in Canada and have adequate education why are you so concerned? Is your position in jeopardy? Have you not gotten more than 3 ETIs this year? Are you a bad intubator and take this personally or have nothing to show you know what you are doing? Does your company not track your procedures? While I have my roots with the FD in this area, I am not so blind that I don't see a problem. When you continue to argue that the EMS systems in the U.S. are perfect and there are no problems, nothing will change. FDs are taking over a large part of EMS and I don't agree with the way all of them are doing this. I do know FDs can do EMS very well given the resources and medical oversight. I don't argue blindly about a system in Canada that I know nothing about.

Again, the LVN at a nursing home probably won't be applying to a Flight team. Get over you attitude about nurses. We've got just as many idiots in EMS and some are on this forum who can't get an original thought for themselves without feeling the need to bash another profession to make themselves look good. How about some links instead of he said/she said? I also form my own opinions when reading what people have to say on an anonymous forum regardless of how high of an opinion you have of someone going by "Letterman". Dr. Wesley also was trying to say the U.S. EMT-B and Canadian "BLS" were the same in his JEMS review. Again, don't just refer to just the abstract. Read the full article. Where did I ever state to take away all the ETI? I stated that it is time to reexamine how we do things and assess skills. Doctors have been studied as have RRTs, RNs, PAs, CRNA, and NPs. Again, trying to drag down another profession as an excuse to ignor what is happening in EMS is not the way to correct a situation or many situations. Is it really a good justification if you miss a tube to say "Ha, ha, Dr. Smith can't tube either. I saw him miss."? That is just juvenile to not take responsibility for one's own actiions. I'm glad you brought up NICUs and Trauma centers. If a NICU is rated Level 1, we DO NOT use nursing assistants instead of RNs. If the rating is Level 2, we DO NOT use LVNs and save the RNs for Level 3. They are all RNs. The doctors also have M.D. or D.O. behind their name. Their base education is all the same. PLEASE DO NOT say that the EMT-B with 120 hours of first-aid training counts as a "base" education. The skills in it are essentially the first week of most professional curriculums. I'm also going to address FL_Medic's article here. The article clearly stated where the study was done. The article also clearly gave a background of Miami-Dade. Yes, FL_Medic, that is MIAMI-DADE and not just MIAMI. This department is the result of over 25 small municipalites merging in just the past few years. There are almost 72 stations. ETI or any other "skill" had not been an issue before this happened when there was excellent medical oversight of the smaller departments. Quite possibly the only way to get the attention of some is for the hospital to do a study since what happens in the field also affects what the patient will go through in the hospital. Hence the words "Trauma System". The area has now identified and made known its problems and can deal with it. People want some evidence there is a problem, they have it. They must address it or continue to make excuses and stick their heads up their butts to hide from the realities of patient care. BTW, Dade county is no longer the retirement capitol it once was and hasn't been since the 1980s. Seattle is not an entire county. They do many, many less calls. However, their studies have also gotten their share of scrutiny. There was also discussions about their procedures for RSI, intubation and central lines in that it is not always because they should but because they can. How many "skills" or procedures did they do to make their numbers look good on patients that may have also down well without advanced intervention? Criticize all you want but you really should wait and see what steps will be taken in Miami-Dade for improvement. I think it will be a turning point. L.A. and other California counties as well as Washington DC or any other large metro FD can then take notes one these findings and the outcomes.

It is the way the terms ALS and BLS are used to justify a level of provider instead of addressing patient care. A patient should also not be classified by the level of the provider especially when they are going to a facility providing a higher level of care than "BLS". Even those that drive dialysis patient to the facility should realize that dialysis is an "advanced" procedure for all practical definitions even if the EMTs do very little for that patient which that in itself can be a topic. Patients sick enough for dialysis are not "BLS" in terms of medicine. I could use the example of other professions to demonstrate how they perceive "medicine". A school nurse RN is usually required to have a BSN instead of just the two year degree even though most of the work might be minor boo-boos, handing out meds already prescribed, record keeping and calling the parents or 911. The intervention is not emphasized but rather the responsibility is the issue.

tnuigs, Where did you that quote from? We are talking about the trauma studies done with OPALS. Yes, it is flawed when comparing U.S. BLS to Canadian ALS but the rationale for the advanced procedures are the same. Again, it is the education to know when and when not to do a procedure or which procedure that improves outcomes. It sounds like the guy was dead at scene. If you have a traumatic arrest, how many shots at ETI do you want to try? Did they have RSI capability? What did they assess from that one shot? One shot is all I need to tell me I need to go to plan B but hopefully I can discover that with my assessment before the blade. Did the medic also pull the CombiTube out? Was there trauma interfering with the placement? The terms "BLS" and "ALS" need to seriously depart from EMS. I do "BLS" stuff in a high acuity ICU everyday.

This assessment, regardless of the letters used, should have been taught in Paramedic school when you were learning to intubate. Without knowing some of these factors you are just lifting and poking without rhymne or reason. You have to think of anatomical structures to choose your blade, position or stance and point of leverage. Or, you may measure the risks and go with an alternative airway.

Read the full study. Also, remember it was the Canadians who studied trauma patients in OPALS. I known nothing about this hospital and their Flight RNs. However if you say the Canadian nurses are crap then maybe they need to look closer at improving. I can only speak for the Flight programs here in the U.S. and RNs I am aware of and they are definitely not idiots when it comes to providing quality medicine.

All good advice but still it is in the identification of the problems to intubation that is the biggest part of the battle. We do now have a "large" population of patients who require 20+ cmH2O just for nocturnal CPAP. While the advice here is good, one also should think about plans B and C before even the repositioning should it not doesn't work. Some here may not want to sound like they can't intubate since we just had the other thread. However, the penalties come from failure to identify rather then going to plan B. This is an issue or hospitals wouldn't be spending $1000s of dollars on difficult airway carts. The idea is to identify and establish an airway while doing the least amount of harm which can be just as deadly as the misplaced tube. We also had a thread on this forum a while back where a couple of people criticized doctors for using the latest technology to intubate difficult patients and poked fun at them for not intubating like Paramedics. One way does not work for every patient and again the goal is to do what is best for the patient. These tips may work but you need to assess your patient just like you were building a difficult project in a tight space. You need to identify the obstacles and understand which way you are moving the anatomy or why. Choose your method and tools carefully. This applies to all patients and not just those in a code situation. It also applies to whether ETI, LMA or BVM can be used safely and successfully.

LOL! It seems like you've tried very hard to convince me of that which usually means a nerve has been struck. It seems like you still focus on "skills". Paramedics did chest tubes and central lines for years but found there was little need on most ground EMS trucks to hang on to these skills. Yes, we can still do them on Specialty and Flight but that doesn't mean we will or, in most cases, should. Knowing when to do them and when not to do them is just as important as the actual hole poking skill. Open cardiac massage is just like CPR. Whoever is around gets to do the deed. If you are working in a Trauma unit, CCU or ICU, that is a "skill" one should be familar with. spenac, I seriously miss your sarcatic debates. You just had to turn into a gentleman and an almost perfect one at that.

20 years and you seem to have no respect for nurses and MDs? That must have been a rough 20 years for you and those that had to work with you. The one thing that working in a hospital has taught me is teamwork with many different professionals as well as respect for their abilities and education. If you see yourself as being constantly criticized by RNs and MDs, then maybe you have some security issues of your own or you are giving them a reason to criticize you. I do realize that some who have the lesser certs and lesser education do feel "picked on" but you must realize those with the higher credentials and education are not the ones holding you back. When you stop blaming others, you can move forward. Who started the name calling? Were my posts intimidating to you? Bullying you? Gee whiz... Move on and stop blaming nurses and doctors for any shortcomings you have or for the shape of EMS around you.

You are not off topic but rather right on the subject. Many spend time practicing on a manikin that simulates a 70 kilo patient. Too few are taught to assess difficult airways. Too many pick their one favorite blade and fail to learn where the other blades can be useful. Some use the "BLS" and "ALS" crap to guide their way whether they use an alternative airway. "Only EMT-Bs use King tubes or BVMs...not real Paramedics". Maybe there should be closer monitors for those that don't get at least 2 tubes per year. Maybe there should be fly cars with an experienced Paramedic to do all the "advanced" stuff and then turn the patient over to the other medics to monitor on the way to the hospital. Maybe there should be more mandatory retraining periodically. Maybe there should be a time limit one can hold a Paramedic cert if not employed with an ALS agency without repeating certain parts of the curriculum.

This is what I wrote in case you missed it the first time. I disagreed with your remarks about critics. Why must you resort to such ludicrous arguments such as the nurses are just jealous or resentful? Is this the 2nd grade? No, nurses are not just out to criticize EMS and considering nurses have many more protocols that they can initiate when out of the hospital situation (and inhospital also), I doubt anyone feels threatened by Paramedics. Doctors are also now held accountable for their actions and if they fail, there will be someone to remind them now with the changes in the way a hospital gets reimbursed. You essentially restated what I was disagreeing with you. The hospitals have already analyzed their areas that need improving. For once why can't EMS do the same instead of blasting people that do point out situations that may need some improvement? Read the posts before you start with the name calling. It is amazing that some must resort to name calling when they fail with having an appropriate argument.

Are you really that insulting of our flight nurses? The LVNs from the nursing homes usually do not apply for a flight or Specialty position. Those that we get to apply are well educated and have an average of 5-10 years in ICUs. Those that want those jobs have no problem stepping up to the requirements. We could also talk about the Paramedic that only does BLS transfers for many years without intubating or starting a line and then finally gets hired by a 911 service. Or one that has flipped burgers for several years with his Paramedic cert while waiting to get picked up by a FD. Or the Paramedic that does only 5 calls a month. It is too bad that your hospitals do not have more QA stanards than to allow your RRTs and MDs butcher airways in the hospital. If we butchered an airway or misplaced a tube as an RRT, you can bet we would be removed from the patient care areas until the hospital attorneys and the state decided our fate. In CA, one RCP did the unthinkable and now all the RCPs in that state feel the consequences. Nurses are also feeling the effects of the actions of a very few. Yet, when something happens in the world of EMS, how may examine their own abilities or protocols to see if they are covered? Instead, some would rather cry foul without seeing what they can do to improve their system for the benefit of the patient. It is unfortunate that some hospitals must rely on GPs to intubate. They are not allowed in any of the areas I am familar with and I do know of some ED physicians from the rural areas that come to our intubation classes and ORs for more experience. How many RNs when they miss an IV say there are studies that show Paramedics miss IVs also as an excuse? How many RRTs would be able to get away with saying that about missed intubations? Again, trying to show fault with others does not give Paramedics the "right" to not be accountable for their abilities.

Critics? Everyone is picking on EMS..boo hoo. Did one happen to think about the environment you work in? Hospitals may also change out lines from other hospitals or those done in an emergency situation or under less than idea conditions even if it is in their hospital and done by one of their doctors. If a line is set up with an open port, the whole line is changed. Meds from another hospital are changed out. Florida is even changing the wording in one of it statutes to have the rec'g physician determining what needs to be done for interfacility transport rather then the referring. Enough with this "oh woe is me the poor picked on Paramedic". There is a patient involved and whatever can be done to prevent an infection will be done.

Spenac, your situation where you have an hour's drive to a hospital is not the norm for everyone in EMS. Maybe some have not become proficient in alternative airways or the use of the BVM. One of the first things we learn even working in the hospital is how to maintain an airway by various means. If you do flight, you definitely learn alternative means because you prepare for the worst and hope for the best. Look at the Anesthesia docs. Very few ETIs are done now in the OR. This is also one reason why Paramedic students can not get the intubations they need during their OR rotations. Very few will allow ETI just because. Yes ETI is a definitive airway but one should NEVER limit themselves to just one way of establishing an airway. I guess I now know why some Paramedics/students have that deer in headlights look when their assistance is requested for a couple of minutes to bag an apneic patient or one requiring ETI on scene or in the ED. They may have gone straight to performing ETI on a manikin and failed to learn other important things like a BVM or alternatives. I also find it just as tragic for the patient when the pharynx and cords are so butchered with repeated attempts that a trach will be required, quite possibly permanently, because some didn't know how to assess a difficult airway and consider alternative methods. Or, when they have been told "Paramedics only do ETI" and their ego or pride make them jab away to get that tube. Regardless of how long it takes on scene (or even in the back of an ambulance sitting in the hospital driveway) or the damage they do, they must enter the ED with a tube. Of course, you also have the other end of the scale where some can't be bothered to do ETI. RNs are much easier to train for maintaining an airway for Flight and Specialty teams because they have no preconceived notions or egos of what must be done because they have seen many different airways used and have had to become proficient in the use of a BVM if they are assisting the intubator. That could also mean bagging for a long time if it is a teaching hospital and the attending decides to lecture first. RNs have had to learn to be versatile when going from one unit to another and learning different procedures or adapt what their know to do it another way. When training Paramedics, they usually have one way set in their brain and that is it. I am not one for removing ETI totally from prehospital but maybe the training and attitudes need to handled differently. Maybe more emphasis should be placed on airway assessment and determining necessity or difficulty instead of just doing a skill. I also know you have read the intubation threads on the forums by the students who talk about "getting tubes". How many acutally discuss the airway? They might as well be intubating a manikin.

One study and a "slight" numerical edge is not going to convince the State and Federal Insurances especially since EMS has not been able to convince them of much even pertaining to EMS with the fragmented levels of various hours of training. Of course there might be services that do have better stats then others but the environment may still against them. As I mentioned before, EMS has been its own worst enemy with "the EMS way" or "do it in the trenches" or "street medicine" and how different EMS is with no time for that hospital technique foolishness. IVs can also be in the same predicament that ETI is in. Too few numbers to demonstrate proficiency for each Paramedic can go against them. Again you have to look at this from the view of a health care system and do what is best for the patient so that they make it from prehospital to discharge without additional complications. Egos need to be set aside so one can look at the bigger picture clearly. If doctors have had to come to terms with this a Paramedic should be able to. Doctors in the units are now scrutinized for handwashing, stethoscope cleaning, procedures and even the clothes they wear in the patient care areas. EMS is still not that diligent. We still have to tell EMT(P)s to remove the gloves they brought the patient in with before they reach for the coffee pot at the nurses' station or do their charting at the front desk. We've also had this same discussion about central lines as now they are falling out of favor for flight teams. I also remember the same reactions from EMS providers when subclavian central lines, intracardiac epi, chest tubes, pericardiocentesis, Bronkisol, Alupent and Bretylium were removed from everyday use for ground EMS. It was hard to imagine life without any of these interventions.

It is not lawsuits. State and Federal insurances will not pay for the infections. A "simple" course of antibiotics can be quite expensive and extend the hospital stay by several days. One infection can have a catastrophic effect on a patient's hospital stay and recovery. This is a little more than just the CYA or "we don't trust EMS providers" but rather the outcome of patient care must be considered. However, EMS has done it own part where IVs are concerned with "the EMS way" or "do it in the trenches" or "street medicine" and how different EMS is with no time for that hospital technique foolishness. This has been required reading for almost every healthcare professional in the hospital The Checklist http://www.newyorker.com/reporting/2007/12...fa_fact_gawande

But is ETI always the best course for prehospital? We know what has to be done in the hospital which sometimes also includes changing out field tubes to place one that will help prevent VAP or make a ventilator stay for more than 24 - 48 hours safer and more adaptable to the hosptial technology. The Federal and State insurances have spoken loud and clear. They will not pay for infections and complications caused by medical professionals. EMS has yet to feel that bite but yet many forget healthcare is a system, especially trauma, and what happens or doesn't happen in the field can directly affect outcomes in the hospital.

If the authors of this article wanted to make a point they could have chosen a better example than someone with sickle cell disease. It is predominantly a trait in African Americans here in the U.S. and often they are not able to work near the end of their life expectancy which is 42 for men and 48 for women with sickle cell anemia. However, with another variant of the disease they might live until 60. It would be like saying someone with Cystic Fibrosis is always calling for an ambulance everytime they can't breathe at they are nearing the end of their life expectancy. Believe it or not the statistics do have a bearing on how some view their disease and choose to take care of themselves. We see those with CF from the ages of 16 - 24 most often in the hospital because it hits them that they are now adults and the future kinda sucks with the medications and lung transplants even if they can maintain a decent quality of life. We also see the same age group frequently for sickle cell. Those that have sickle cell may also know that no matter how well they take care of themselves it just takes one serious event to diminish their quality of life further. Treating the chronically ill is almost a specialty in itself. There is usually no miraculous cure even with the blood transfusions or transplants. I see this all too often with I test the lung function of an 18 y/o whose CF is progressing rapidly and their lungs are crap. While you try to be upbeat and encourage compliance, you just look at their breathing on a good day for them and can't help but see where their own attitude is coming from. Many become non-compliant but then become our frequent fliers when they realize that their body doesn't do well without proper care or they realize the end might actually be near. Ambulances actually only see a very small percentage of those who come into the clinics and hospitals for a wide variety of reasons. It is like when some complain about "all those dialysis runs". What many don't realize is that ambulances again only transport a very small percentage of those on dialysis but since it is your truck, you might think 2 transports a shift is a huge percentage of your calls. One has to step back and look at the makeup of the healthcare system as a whole and essentially that is what the associations for NPs and PAs have done. Through their understanding of issues they have gained support and strength. Right now prehospital medicine is too narrowly focusly on just the emergent conditions and are not ready to dictate the care for patients with complex medical needs. Even the NPs and PAs realize that they also must ramp up their educational requirements to Masters and Doctorate to keep up with the demands of healthcare and the medical needs of the patient. Meanwhile, EMS is still debating the next cert or patch to obtain.

Maybe education is important? It is hard to believe they have as little as 500 hours or 3 months to train their Paramedics. But, at least they seem to be correcting that. But unfortunately the U.S. still has many systems that are "BLS" only with the 120 hour EMT-B and often volunteer running on a limited budget. There are also many EMS systems in the U.S., even in well known systems, that do not do 12-lead EKG, do not do RSI, do not have ETCO2 monitoring, do not have CPAP and must still transport to the nearest facility even if the more appropriate facility is only a couple blocks away. Most of these things are not even mentioned in the U.S. Paramedic programs. So no these are not necessarily part of an ALS truck in the U.S. Even in some of the systems they have been placed in, inadequate training and education have lead to complications and scrutiny. For 12-lead, some must rely on the machine interpretation. For RSI, often the recipe is inadequate for many of the patients which sets the Paramedic up for failure.

If I was on dialysis 3x/week, I don't know how I would behave. I honestly can't say if I would try to eat lettuce all the time or enjoy the foods I have deprived myself of all for staying healthy. Many gain the weight after the dx of an illness because of depression and immobility. Unfortunately we don't see these patients on their good days but only on their bad ones. For some, everyday is a bad day. COPD pts constantly attached to an O2 tank are also considered abusers of the system but yet few know what their lives are really like until they themselves are in that situation. And yes, they do call everytime the weather changes but their bodies can no longer adjust like it used to before they had any need for 911. However, it is unfortunate that some in EMS are also becoming a permanent part of the health care system due to their own health habits. Smoking and obesity are taking its toll and there are now many articles as well as deaths to document it. There is not an EMS job description that says you must smoke and eat fries or donuts everyday. I recently go bashed on this forum for pointing out that there are now numerous EMT(P)s collecting and trying to collect workmen's comp for their health problems which can be largely attributed to lifestyle. That also sucks up a lot of insurance and healthcare funds as well as missed work days. Yes, it is a serious healthcare expenditure that affects many areas. Some of them are also the "frequent fliers" in the EDs and hospitals. They are actually a bigger problem because they use their medical knowledge to play the system. However, some believe those in EMS are exempt from the same issues they complain about concerning others.

Police union or not the Paramedics should know their job and have the support of their medical director when either working or not working a patient. However, in this situation, they left the scene with a live patient laying there and it WAS THE POLICE that called them back. That sorta puts the PD in better light than the Paramedics in this situation. I think there should also be clarification between "obviously dead" and the "newly dead but not obvious". For the "obviously dead" even an EMT-B or layperson would probably have little difficulty in calling that.

It appears the same Paramedics were called back to take another look. It also seems there is some confusion amongst the Paramedics and Police as to "signs of life" and calling patients at scene. The earlier article: Dead, not dead, at shooting scene Baltimore paramedics prematurely pronounced a patient dead over the weekend while at the scene of a police involved shooting in Northwest Baltimore. The Sun's Richard Irwin reports that an investigation is underway by the Baltimore Fire Department (at left, din a photo by The Sun's Glenn Fawcett, detectives stand over a body at a homicide scene in West Baltimore). This comes just a few months after we heard complaints from homicide detectives that paramedics were following new rules and taking even obviously dead patients to hospitals, marring crime scenes. Detectives like having their scenes untouched, including bodies, so they can learn as much as they can. This case stems from a shooting by a city officer of a burglarly suspect at a grocery store. Cops say the man lunged at officers with what appeared to a knife but turned out to be a screwdriver. The man was hit in the head and paramedics prounced him dead at the scene and left. But later, homicide detectives noticed that man either moved or made a sound and called the paramedics back. The man was taken to Maryland Shock Trauma where he remains in critical condition. Fire commanders are investigating what went wrong. We had heard from cops and paramedics that they are quick to transport at even the slightest sign of life. One paramedic told me that "if we see life, we do something." Even obviously dead patients sometimes get treatment, the paramedic told me, such as when a man has been shot in public and his friends and family are around. The paramedics want to make sure the family sees that everything possible has been done. The paramedic told me that in one case, an elderly woman died in a nursing home and she was instructed to take the victim to the hospital anyway. "If it was my son up there, I'd want somebody to do something," the paramedic told me. "If they guy is lying on the porch and his relatives and family are all around, I want them to know that I worked him." Some homicide detectives have complained that bodies are being moved unnecessarily, complicating their efforts at scenes. But Robert Cherry, the president of the police union and a former homicide detective himself, said he hasn't heard any grumbling. "A lot of our detectives want to spend a little more time at crime scenes looking at it the way it was," Cherry said. "But I can see a paramedic saying, 'I'd rather have Shock Trauma pronounce the person dead.' If there is even the slightest chance of survival, EMS has to do their duty and protect life. Where a body is there or not, we'll still do our jobs."

http://www.latexallergyresources.org/ Go to: Links and Resources > Products > Consumer Products

Some sources have the increased Polymerization of HbS at a PaO2 < 75 mmHg. One should consider the accuracy of SpO2 in sickle cell anemia. The pulse oximeter can over estimate or under estimate arterial oxygenation. Various factors contribute to this variability. The analyzer calculates the saturation value based on data from individuals with normal Hb. Most of the blood gas analysis equipment calculates oxyhemoglobin saturation by measuring arterial oxygen tension (PaO2) and applying a standard oxyhemoglobin dissociation curve. Patients with sickle cell anemia present a oxyhemoglobin dissociation curve shifted to the right. Hemoglobin is 50% saturated (P50) at a PaO2 of 42-56 mmHg in patients with sickle cell anemia, compared with a mean of 26.5 mmHg in the general population. Therefore, patients with sickle cell anemia can present an SpO2 < 90% and, nevertheless, present a PaO2 > 80 mmHg. In other words, using the oxyhemoglobin dissociation curve to calculate SpO2 in patients with sickle cell anemia generates misleading data. But hopefully in many cases the SpO2 "might" be lower than what a measured PaO2 might be measured as. The PaO2 measurement provides a more precise evaluation of arterial oxygenation in sickle cell anemia. PaO2 is therefore the best indicator of the risk of vaso-occlusive crises.

If you ever felt the same pain that someone in a sickle cell crisis is experiencing, to them that is an emergency. Fortunately most on this forum are blessed with good health and may not or hopefully will never experience a disorder or debilitating disease to where they do understand where some of their patients are coming from. As well, many feel like they have nothing else or no alternative and the disease has consumed their whole life which each day consisting of trying to find some comfort. This doesn't just apply to adults but to children also but many young children have other coping mechanisms like just shutting down and withdrawing. Sickle cell is no joke and several patients have already been on ventilators. Each time they get that feeling of shortness of breath they may remember their last ICU stay. Granted many do just need their labs monitored and medications adjusted but I would hate to tell the one that is developing acute chest syndrome to call a cab.