O2 administration

[YoungEMT95]

Has anyone had a service change its O2 protocol due to the finding that it can be harmful to patients in the long run?

[JPINFV]

No, but none of the places I've worked required something stupid like everyone gets a NRB at 15 L/m

[DFIB]

We titrate for effect according to SPO2.

[celticcare]

Our protocols here *and I don't have them on hand but dont worry Kiwiology will no doubt post them *

state that oxygen is given only to maintain an O2 saturation level above 95% and is only given to patients if they are heamodynamically unstable. O2 is given via NP and only at higher levels if unstable or requiring it. I am trying to get a change within our hospital which still blasts patients with at least 6 Litres of O2 for anything, I had a fight with a fellow nurse who tried to blast me with 6-10 litres of O2 when I was in with my heart playing up and refused high level O2. I hope a change comes about, Prehospitally it has come about, so now lets see if it changes in the hospital.

[Kiwiology]

Oxygen is a specific treatment for hypoxia (hypoxaemia) only. It is not a "general treatment" for patients who are injured or unwell nor is is a treatment for ischaemia, tachyponea or an altered level of consciousness.

Prophylactic administration of oxygen is inappropriate and supraphysiologic hyperoxaemia (a greater than normal level of oxygen in the blood) causes small arterioles to constrict which reduces blood flow. This is particularly bad for patients with myocardial ischaemia, stroke or shock and the evidence appears to indicate greater mortality in myocardial infarction patients who receive supplemental oxygen.

Remember, ischaemia is not hypoxia (hypoxaemia) and that oxygenation is not ventilation; the concepts are very different. Ischaemia is localised whereas hypoxaemia is global and if a patient has an ischaemic myocardium because of an occluded coronary artery(ies) then cramming more oxygen down his throat is not going to break up the clot now is it?

Only give oxygen to patients who need it, and in the lowest concentration required. Most patients only need nasal prongs or an acute (ordinary) mask.

Oxygen is a drug, remember that, you wouldn't give somebody 100mg of morphine if they only require 1mg would you? so why give somebody fifteen litres of oxygen when they only require two or three?

[Bieber]

I expect our new protocols to say something to the effect of "maintain spo2 at 94% or greater".

Not even quite sure what our current protocol says... I just give it when I think it's appropriate and don't when I don't.

[Kiwiology]

If only we thought you were appropriate ..

Oh snap did I say that, my bad

[YoungEMT95]

My area wants us to maintain SpO2 at 94% or higher, but we do not have to. Some paramedics in this area will not give oxygen for certain cases because of its harmful effects, especially when it comes to copd pt's.

[Kiwiology]

Well, it's a good idea if you maintain SpO₂ > 95% for the patient

[YoungEMT95]

im not saying its a bad idea, i was just wondering if any other services have different protocols concerning O2.