Pediatric respiratory care

[musicislife]

Having a rather heated discussion with my CC about this one..

We had a 4 y/o male, pretty large for his age, with an apparent asthma attack. His SpO2 was 89%, I decided to use an Pediatric NRB on the PT. He tolerated it just fine, and his SpO2 increased. My CC got upset about that at the end of the call and said I should have used o2 blow by with a paper cup and o2 tubing. Which do you guys think is more beneficial in these situations? Blow by or NRB? It seems to me based on his presentation and response to treatment that the NRB worked just fine.

[scubanurse]

CC? Again, please know this is an international forum and most abbreviations are not universal.

A 4 yo can tolerate a pediatric NRB, and if they do then use it. No reason not to in this case. Blow by is not as effective as a NRB and as long as you have a good fit and the kiddo tolerates it, I see no problem with it.

[DwayneEMTP]

I'm not sure what a cc is either...

But if they really got upset in this situation then they're not terribly bright and I hope that cc doesn't imply some type of training position..

Use an intervention that requires both of my hands to be occupied, or one that leaves them free to do other stuff, like, say... Vitals, lung sounds, etc..?

Yeah Brother... You were off in the ditch... Tell your cc that next time you'll be sure to prove to the world that you know the 'paper cup trick' instead of continuing to do medicine instead...

Grrrr... This stuff makes me crazy...

Good post man... These are important points that, truly, can't be repeated often enough... Think instead of follow... Good on you..

[MariB]

A 4 year old can usually tolerate a NRB for crying out loud. The paper cup trick? Did he want you to paint a fishy on the bottom of it too?

The kid is probably used to things on his face. It isn't like he was a year old. Then blow by is a better choice.

[Aussieaid]

NRB is always a better choice even for an infant if they tolerate it. IF they don't then you use a different option like blow by with a regular NRB. You can often tape the mask below their face or even wrap a teddy bear around it and position it as close as possible to them. I'm not sure what a paper cup is going to do better than a NRB? Seems like a regression in treatment to me.

A 4 year old asthmatic is probably used to using masks for home treatments most likely anyway. We put kids and infants on NRB's all the time... they don't all get upset about having a mask on or near their face. They often tolerate it better if a parent is holding it as well.

[MariB]

NRB is always a better choice even for an infant if they tolerate it. IF they don't then you use a different option like blow by with a regular NRB. You can often tape the mask below their face or even wrap a teddy bear around it and position it as close as possible to them. I'm not sure what a paper cup is going to do better than a NRB? Seems like a regression in treatment to me.

A 4 year old asthmatic is probably used to using masks for home treatments most likely anyway. We put kids and infants on NRB's all the time... they don't all get upset about having a mask on or near their face. They often tolerate it better if a parent is holding it as well.

It would be rare for me to use a nonrebreather on an infant unless a blow by or cupping my hand wasn't working. If the o2 SATs were really low and I felt I had too, we would seriously be watching the pulse ox and the patient...

[ERDoc]

The job is to get the pt the oxygen he needs and it sounds like you did that. I'm going to assume CC means crew chief and I don't know what his problem is. There are all of these stories and myths that get propagated in EMS that need to stop. I still remember my EMT training where we were told to do the cup method IF the pt would not tolerate a NRB. It seems to me like your CC forgot the IF part. You did fine and got the job done. Don't let his misunderstand shake you. If he gives you any slack, refer him here. We'll set him straight.

[musicislife]

Thanks for the replies. I'm so used to using my squads abbreviations. Cc means crew chief, the emt in charge

[MariB]

Hmmm, we have a director and an assistant director, other than that, on scene we are in charge and I've never (yet) had to justify my treatments. A 4 year old needing o2, having an asthma attack, can handle a non rebreather.

[ERDoc]

Mari, that is because you haven't been with a volley on the east coast. At my VAC, if you didn't have a crew chief, the ambulance didn't move, even if you had 5 EMTs. Luckily we saw the problems with this and did away with it. It was actually pretty funny at times. We had this one 21 year old stereotypical blonde who they made a CC (I'm going to use the abbreviation since we've established what it means in this thread). No one had much respect for her (it was deserved). People who were much better EMTs than her would pretty much ignore her on calls and do what they needed to do. She would come back to HQ after the call with her face crunched up and stomp around saying, "I'm the crew chief. You are supposed to listen to me." I think she was one of the main reasons we got rid of CCs.