O2 administration

[DFIB]

I did not read every reply but I was I was told during my training you can never go wrong with administering o2.

Not that I use it with every PT. LOL

Here are a couple of studies that talk about O2 administration in MI patients and the effects it has on the ischemic tissue.

http://www.thecochranelibrary.com/details/editorial/742329/Oxygen-therapy-in-acute-myocardial-infarction--too-much-of-a-good-thing.html

http://www.rsm.ac.uk/media/downloads/j07-03oxygentherapy.pdf

Enjoy!

[emtdennis]

"So no titration of O2 to maintain something resembling physiologic norms for a patient's pathology? Just 6 LPM or nothing?"

It was 6 lpm generally for the pt with COPD, any other pt = up to 15 lpm only as needed. Good news is that the protocols should be changing this year

[mikeymedic1984]

Giving high flow O2 to a child with hypoplastic left heart syndrome can be very deadly.

[eb1040]

Giving high flow O2 to a child with hypoplastic left heart syndrome can be very deadly.

Not giving an oxygen concentration of 100% for Persistent Pulmonary Hypertension of the Newborn (PPHN) can be deadly.

Not knowing the causes, history or differentials between a ductal dependent lesion and PPHN is deadly. Generally in a stressed delivery outside of the hospital with a term infant whose mother may have had prenatal care, PPHN would be suspect or be aware of the potential with appropriate treatment. Continuous monitoring of both pre and post pulse oximetry should be done with any distressed infant initially.

The high flow generator or device may not be necessary since an infant's minute volume is low but the flow should be compatible with the device. Depending on the device used you don't need a large liter flow to allow oxygen FiO2 consistency in babies and children since they will not have a large inspiratory demand for the mixture. The exception might be for an infant who has a ductal dependent lesion and is not intubated. In that situation if you opt for subambient oxygen therapy you may wish to use a high flow device that ensures it is well about the infants peak demand to prevent any contamination of room air @ 21% especially if running at 16 - 18%.

.

[DFIB]

Here is the link to an article that somewhat brings home the consecuences of high flow O2.

http://www.ems1.com/columnists/mike-mcevoy/articles/1308955-Can-oxygen-hurt/

[twist27896]

This brings into mind a recent incident. As an EMT-I I generally take direction from the higher level provider (EMT-P) On one call with a patient complaining of difficulty breathing, the paramedic scolded me for giving high flow (15 L/min NRB) to an asthmatic patient whose SP02 was in the very high 80's. He took off my NRB and gave the pt. 2 puffs on her inhaler and then 3 LPM via NC. The patients SP02 was slowly dropping into the mid to low 80's but the medic insisted on no NRB/high flow 02. He ended up driving and leaving me with patient care in the back. Due to the dropping SP02, increasing respiratory distress, and at the patient's insistence, I switched over to high flow 02 with almost an immediate (2-3 minute) improvement of SP02 and respiratory distress. In this case I did not argue with the medic but inside felt I had made the right choice against the medic's instructions. While 02 can possibly hurt a patient, it is very unlikely in the short time we treat them (in my opinion). I believe it can be extremely dangerous NOT to give 02 and mildy or arguably not dangerous to give 02. As an Intermediate level provider, I believe that ALS level technicians often forget the BLS aspects of patient care (i.e. giving 02, stopping CPR to give ACLS, not backboarding/taking CSPINE seriously, etc.)

[BushyFromOz]

oh gawd, can we not do this again?

:bonk: :bonk: :bonk: :bonk:

[craig]

I keep forgetting BLS save EMT I butts and then the EMT I save the Paramedi one...........old sh*t that wears thin....been on both side of the argument, really dont care what people think...we are there for the PATIENT

lets drop this line now PLEASE..............

[rock_shoes]

This brings into mind a recent incident. As an EMT-I I generally take direction from the higher level provider (EMT-P) On one call with a patient complaining of difficulty breathing, the paramedic scolded me for giving high flow (15 L/min NRB) to an asthmatic patient whose SP02 was in the very high 80's. He took off my NRB and gave the pt. 2 puffs on her inhaler and then 3 LPM via NC. The patients SP02 was slowly dropping into the mid to low 80's but the medic insisted on no NRB/high flow 02. He ended up driving and leaving me with patient care in the back. Due to the dropping SP02, increasing respiratory distress, and at the patient's insistence, I switched over to high flow 02 with almost an immediate (2-3 minute) improvement of SP02 and respiratory distress. In this case I did not argue with the medic but inside felt I had made the right choice against the medic's instructions. While 02 can possibly hurt a patient, it is very unlikely in the short time we treat them (in my opinion). I believe it can be extremely dangerous NOT to give 02 and mildy or arguably not dangerous to give 02. As an Intermediate level provider, I believe that ALS level technicians often forget the BLS aspects of patient care (i.e. giving 02, stopping CPR to give ACLS, not backboarding/taking CSPINE seriously, etc.)

Beyond any of the rest of this I have to ask, why didn't the patient get more albuterol/atrovent than "a couple puffs" of their own inhaler? In a serious bronchospastic event 180-200mcg of albuterol is pretty negligible. 10 puffs of albuterol with a spacer or albuterol/atrovent 5mg/500mcg by neb is more realistic for a first dose. If an asthmatic patient is calling for EMS their own rescue inhaler probably isn't cutting it for them during this event.

Without knowing more about the incident, it would seem you both dropped the ball on this one.

Sent from my A500 using Tapatalk 2

[DFIB]

Beyond any of the rest of this I have to ask, why didn't the patient get more albuterol/atrovent than "a couple puffs" of their own inhaler? In a serious bronchospastic event 180-200mcg of albuterol is pretty negligible. 10 puffs of albuterol with a spacer or albuterol/atrovent 5mg/500mcg by neb is more realistic for a first dose. If an asthmatic patient is calling for EMS their own rescue inhaler probably isn't cutting it for them during this event.

Without knowing more about the incident, it would seem you both dropped the ball on this one.

Sent from my A500 using Tapatalk 2

Funny how that works out.