Why is O2 required in this case?

[Jim Squire]

I'm learning to become an EMT, so be easy on me for asking this newbie question, but it points to something about O2 adminstration that I don't understand.

Virginia's health department posts a bunch of scenarios for EMT training like this one:

http://www.vdh.virginia.gov/content/uploads/sites/23/2016/05/M003.pdf

In it we find a young adult diabetic patient with a Rx for insulin, able to speak but not feeling well, alert and oriented x3 but "sluggish to respond" and a CC of "not feeling right".  He has an O2 sat of 95 and respiratory rate of 14, no mention of cyanosis, vitals normal except for low glucose.  Why does the grading criteria call it a critical fail to not provide O2?  As a not-yet-certified EMT student with no field experience, I'd think this pt doesn't seem to be in any sort of respiratory distress; he just needs some glucose paste and continued monitoring enroute to the ER (and probably doesn't even need the ride, but I understand we are always supposed to transport everyone unless they sign waivers since there are problems that require more skill/equipment than we have to Dx.)  Are we supposed to automatically provide O2 for everyone (except those in hypoxic drive), regardless of O2 sat?

Just when I think I'm starting to get a handle on this... 

[rock_shoes]

On 10/15/2019 at 11:15 AM, Jim Squire said:

I'm learning to become an EMT, so be easy on me for asking this newbie question, but it points to something about O2 adminstration that I don't understand.

Virginia's health department posts a bunch of scenarios for EMT training like this one:

http://www.vdh.virginia.gov/content/uploads/sites/23/2016/05/M003.pdf

In it we find a young adult diabetic patient with a Rx for insulin, able to speak but not feeling well, alert and oriented x3 but "sluggish to respond" and a CC of "not feeling right".  He has an O2 sat of 95 and respiratory rate of 14, no mention of cyanosis, vitals normal except for low glucose.  Why does the grading criteria call it a critical fail to not provide O2?  As a not-yet-certified EMT student with no field experience, I'd think this pt doesn't seem to be in any sort of respiratory distress; he just needs some glucose paste and continued monitoring enroute to the ER (and probably doesn't even need the ride, but I understand we are always supposed to transport everyone unless they sign waivers since there are problems that require more skill/equipment than we have to Dx.)  Are we supposed to automatically provide O2 for everyone (except those in hypoxic drive), regardless of O2 sat?

Just when I think I'm starting to get a handle on this... 

Without more information, I'm willing to wager this is likely a matter of local protocol not evidence based practice. Based on the information provided the patient doesn't have an oxygenation problem.

[Jim Squire]

Thanks rock_shoes. Makes me feel like I am learning something. Although I’m a bit surprised that local protocols don’t reflect evidence based research (which is just common sense here), especially as a “critical fail” point.  Well, as I said, I’m new to this. 

[jwiley40]

This sounds like a question that needs to be directed to your medical director. As an instructor/preceptor, we taught that if the patient's Spo2 was 94% or greater, you don't really need to apply O2, unless they are having increased difficulty in breathing. Then, you could to supplement and stave off hypoxia. However, based in the scenario you provided, not enough information noted. Remember this though: treat the patient, not the equipment unless you're an equipment technician. But like I stated in the beginning, this sounds like a question for your medical director. 

[Just Plain Ruff]

So this scenario just reeks of a national registry scenario from years gone by that hasn't kept up with the times.  

Evidence based practice dictates that patients with Oxygen saturation of 95% and no significant LOC changes do not require supplemental oxygen therapy but the scenario says the passing criteria is applicaiton of oxygen and in the competency they even suggest Non-rebreather.  

You are on the right track by not wanting to put oxygen on this guy but again like any other education that we go through these days, we are taught to the test not taught to think independently.  So your state examples are still being taught to the National Registry test which is honestly a dinosaur but we all have or have had to take it so until some group gets a backbone and says "NO MORE TO COOKIE CUTTER TEST SCENARIOS" we will still have emt's and medic test takers giving oxygen to patients with O2 sats of 100%.  

Until you pass the test, my best advice would be to study and practice to the test scenario papers you have and not try to use that beautiful 6 pound piece of gel in your head called your brain, you might just fail if you use your brain.  

 

Good luck

[Jim Squire]

Thanks everyone!  I appreciate the feedback.  It's tough enough to feel comfortable in knowing what to do in a critical emergency, worse to have to juggle conflicting standards of care.  But what's really worse is the feeling that it leaves us vulnerable to lawsuits if things go south.

I could imagine a lawyer saying, "Mr. EMT, please read here, from the AOSS textbook, the standard in the field, about whether to provide O2 at 95% saturation.  And, yet did you provide O2 anyway against this guidance?  And let me ask the expert, is it possible unnecessary O2 administration could cause O2 toxicity that could result in death?"  Or if the I did the exact opposite thing, the lawyer would say "Mr. EMT, please read here from your own state's scenario on a critical failure point for failure to administer O2 at 95% saturation for a patient with low glucose.  And, yet did you withhold O2 anyway against this guidance?  And let me ask the expert, is it possible that withholding needed O2 could result in death?"

Still, I want to train and get certified.  Now, if I can just find an EMT class that's open in my area this summer during COVID lockdown...