O2 administration

[Arctickat]

stopping CPR to give ACLS,

errr, excuse me? Did you mean that they should be stopping CPR to give ACLS, because that's what it says here.

[monkadelic]

@dilaudid yeah thats what the Brady Text said in my class as well

@DFIB about hyperventilation, the only place we had that in the text was indicated in a brain herniation with decorticate/decerebrate posturing via BVM @ 20-22 bpm, so I haven't had the chance to get into the research yet.

The new text book also mentioned O2 toxicity in the breathing/airway module; but also stated it was unlikely to occur in a pre-hospital setting within 30 minutes of transporting a patient to the ER. Granted I am very new and don't know the protocols at my EMS yet; I'm sure I'll get the crash course on them monday in orientation. One thing I do know in this area it is not in our scope of practice to put on a pulse oximeter or stick blood glucose.

But I have transported many of inpatients down to xray over the years where the floor had the patients on NC blasting their eyeballs out at 10-12 LPM; but we are starting to see more inpatients on Venturi's rather than NRB now

Not really sure where this thread is going and not intending for it to run off on a tangent, but just wanted throw in 2 cents.

I read the article DFIB linked and I really liked this statement near the bottom of the page; "Wonder why the 2010 ECC Guidelines recommended against supplemental oxygen for chest pain patients without hypoxia? Now you know: supplemental oxygen reduces coronary blood flow and renders the vasodilators ALS providers use to treat chest pain ineffective." I'm glad I took a moment to read this, because I never would have thought about that.

[Asysin2leads]

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.)

You know twist, I had this entire response ready to go, ready to explain the difference between hypoxemia in COPD and high flow oxygen in the presence of tissue schema, but I'm giving myself a break, so let me just say, you're really, really wrong. You're so wrong I'm not even going to bother going into detail telling you how wrong you are.

[Bieber]

]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.)

Like Asys said, you're wrong about the threat of hyperoxia.

Oxygen is a drug, and like any drug, it should NEVER be given when it's not indicated. You wouldn't give a patient aspirin, nitro, or glucose "just because", would you? There is NO evidence that routine oxygen use in uncomplicated MI's provides any benefit (http://www.ncbi.nlm.nih.gov/pubmed/20556775, https://depts.washington.edu/respcare/public/hmc_files/journal_club/articles/20110912/routine_use_of_oxygen_in_mi-systematic_review.pdf), and as such, it should not be given just because every EMT book for the last forever has advocated for high flow oxygen for any and every condition.

Also, on a side note, there is no evidence of benefit to spinal immobilization. Which may be why you've experienced paramedics who don't "take backboarding seriously".

[twist27896]

@arctickat I was trying to say I have seen some people get so caught up in ACLS that they downplay CPR/BLS in codes (Looking back, I think i worded it weirdly).

Also I am not saying that 02 cannot be harmful but that if a patient is in respiratory distress I think that potential benefits of high flow 02 would outweigh the risk of not giving it. I am not an EMS or medical expert obviously but a doctor I work with did reference some studies saying that in the short amount of time that we are with patients, it is unlikely high flow 02 will harm a patient. A similar discussion on jems takes a stab at this issue: http://connect.jems....en-and-copd-its. I do believe that in the long run too much oxygen can be a bad thing, but my rationale is that in the EMS setting it just seems much more dangerous to withhold than administer 02 when in doubt (a slight but possible risk vs the capability to greatly help the patient). Not saying that every person should be given 02, but if their condition warrants oxygen it seems more more risky too deny high flow than to give it if unsure.

I personally would like to see a change in backboarding policy but so far our protocol is pretty strict and I again would rather be safe than sorry (legally) until our protocol allows more liberal clearance of cspine.

Edited August 6, 2012 by twist27896

[HARDCORE CAP]

if a patient is in respiratory distress I think that potential benefits of high flow 02 would outweigh the risk of not giving it.

this. not everything is black and white, you have to make a choice and stand by it per your reasoning. personally, i stand by the titration method. I want to prevent a hypoxic episode of 02 sat <90 and keep it approx 95%+