Lying for what? (venting a little...)

[firedoc5]

I love the 3ltrs by simple face mask! 2 by NC is more the norm around here. "Gee, we don't know why his SOB didn't improve...we've go the concentrator up as far as it will go!".

If he was only slightly "smurf blue" before, he would have been "blue man group blue" afterward.

[VentMedic]

A simple mask is not the appropriate mask to use for shortness of breath if the patient's MV is more than 6L unless you run it at 10L. Even at that, a patient who is short of breath will probably want more than that easily. A NRBM is also not considered to be a high flow device because only 15 L/m is the cut off flow from that.

Simple masks primary are popular in post op recovery because the patient is still sedated and will breathe a MV of 6L or less initially. They usually have the option to set up a High Flow device with cool aerosol also which may be close to each bed space.

Very few people look at a patient's minute volume when choosing an O2 device. Some still believe they are delivering 28% with 2 L/M NC on a COPD patient when they are pulling in 15 L/m or more of RA with their MV. The same when they think 6 L/m NC is alot of O2 but again if the patient has a high MV, it is diluted greatly. That is why I always find the arguments about how much O2 to give a patient by recipe so ridiculous on some forums.

For some MV is just a formula that was calculated once in the paramedic program but never fully explained how it relates to practical application.

It is not too uncommon for an ambulance crew to disconnect their NRMB from the ambulance tank , leave the mask on, get directions from triage or front desk, go to bedside, wait for ED staff, move patient and then hook up to the ED O2. When I "asked" if they though there was enough O2 going to the patient, they usually reply there's still "some" O2 in the bag. They could at least take the mask off the poor patient. I also see a NRBM or Simple mask with no O2 on a patient to minic the paper bag for "hyperventilation". Unfortunately the patient was "tachyneic" due to infection, fever, acidosis, PE or PNA and needed to raise their PaO2 and maintain a decent pH.

Even the common BVM is not designed to run much more than 15 L/M. Some even remove the reservoir bag or tail because it gets in the way and report off as bagging with 100% because they are still hooked to O2. They believe the bag just "prevents rebreathing" as on the NRBM but since they are doing the breathing for the patient, it's okay.

So, it is not just nursing homes that could use some O2 education. I get to see many ambulances come in during one shift if I'm in the ED and see way too much that indicates the medic mill system is not working that well. And it doesn't just apply to O2. For every incident we can think of for nursing homes, others can also come up with just as many for EMS crews.

[mshow00]

Could it be that the patients vital signs changed between the time they took them, and you took them?

With all things possible, I can not say 100% that what you ask is not possible, however the pts presentation, along with the nurse's account of what his "normal" was, I can not see this being rapid onset upon or arrival. It just dose not fit...

As for the whole O2 thing it is so customary here, it sadly dose not even bother me anymore... I just fix it, and move on. I know not every nurse in ever nursing home is this incompetent, but I fail to see how they keep their licence. If I pulled even half of the crap they get away with I would be sued and looking for a new career. Kind of goes along with taking a CHF pt into the ER out here, if we put give them albuterol we get disciplined, but the first thing half the ER docs do is: order a breathing Tx du du dun! Or even having us work so hard to "bring back" a pulse, and BP in a code, only to have the Dr. blame it all on the meds and let the pt die on his table. Somethings are just so far beyond my understanding.

[itku2er]

Well no place is perfect nor is any profession, But it seems that those of us that work in LTC or SNF get the worse end of the stick all the time, even had a run in with a few MD's that think because I am nurse in a nursing home I am dumb, but far from that. But the bad ones make the rest of us look like we all fit in the same boat. As far as the vital sign difference goes you all know that from the time 911 is called to the time you arrive on scene the vs can change as a matter of fact they can change from the time you load the patient on the cot and recheck them in the back of the truck so to say she was lying you cant with 100% accuracy you werent there you didnt take them so maybe that was what they got maybe not. Some of the nurses allow the CNA to take the vital signs which they rely on and not go back and recheck them themselves. I do however dont agree with them waiting so long to call 911 if they saw such a major decline in the resident why wait all day that is just stupid. Was he given too much ativan since he had no cardiac histroy? Smurf blue isnt good on any patient yeah I have actually told 911 that my patient looked like a smurf but I only did it once.

But every where you go you have people that are burnt out just dont care and that makes their assessment skills and judgement impaired to what their patient needs or they miss things. Not an excuse just the way things are. But then again I am just a Nursing home nurse what do I know :?:

[Just Plain Ruff]

A simple mask is not the appropriate mask to use for shortness of breath if the patient's MV is more than 6L unless you run it at 10L. Even at that, a patient who is short of breath will probably want more than that easily. A NRBM is also not considered to be a high flow device because only 15 L/m is the cut off flow from that /Quote Ventmedic

I wonder how many here can calculate a MV?

[brentoli]

V = V[sub:a0851fb66f]A[/sub:a0851fb66f]+V[sub:a0851fb66f]D[/sub:a0851fb66f]

Well... thats what wiki told me.

[Richard B the EMT]

Admittedly, this is for ambulance folks, not SNF personnel, but...A quick survey here:

Per your local protocols, with a non rebreather mask, do you administer something like 10 to 15 liters per minute?

As for the nasal cannula, when used, 2 to 6 liters per minute?

Final question for the survey. Nasal cannula used when the patient cannot tolerate an NRB mask, or otherwise refuses a mask?

I guess I have to adjust the color on my analog broadcast TV, as "Smurf" blue, and "Blue Man Group" blue appear the same to me.

[VentMedic]

V = V[sub:d7d2baab3d]A[/sub:d7d2baab3d]+V[sub:d7d2baab3d]D[/sub:d7d2baab3d]

Well... thats what wiki told me.

You found the deadspace and alveolar equation relationship for ventilation. That illustrates when I say TACHYPNEA does not always mean HYPERVENTILATION. For those that want a further explanation of this:

http://www.ccmtutorials.com/rs/mv/strategy/page16.htm

Minute ventilation = RR x tidal volume.

[mshow00]

Please don't take offense itk, I have had some of the best nurses I have ever seen or had the pleasure to work with at the SNFs. Hell, I went to EMT school because of my old boss who was an LPN. When I told her my wife was pregnet with our first, she sat me down and made me fill out the papers needed. She then went on to help me when ever I needed it. She was good, damn good. We were under orders to call her anytime one of residents "were not 'normal'", no matter the time. After I got my Basic license (and towards the end of class) she put full stock when what I told her, once she knew she could count on my assessment. I have read your post and have had minimal (thru the city here) contact with you, and from what I have seen you are a good one, but like you said "The bad ones give us all a bad name". I agree those people are everywhere. There are a hand full of employees at my work that I have no clue how they still have a job let alone a license.

[Arizonaffcep]

A simple mask is not the appropriate mask to use for shortness of breath if the patient's MV is more than 6L unless you run it at 10L. Even at that, a patient who is short of breath will probably want more than that easily. A NRBM is also not considered to be a high flow device because only 15 L/m is the cut off flow from that /Quote Ventmedic

I wonder how many here can calculate a MV?

Out of curiosity, in the prehospital setting, what would then constitute "high flow O2?" In southern AZ, we can transport vented pts, but not initiate vents (too bad, cause it'd free up hands during a code).