Was I wrong?

[Juice]

Here are the people involved.

My Boss. Safety Manager and also EMT-Basic (8 years)

Myself. Safey Supervisor and also EMT-Basic (brand new) wishing I could make this much money as a paramedic.

Safety Office Clerk EMT-B for 6+years

Bob (not his real name). EMT-I99 expired last year after 10 years. Took Basic with me and failed NR Cardiac twice (no certification right now).

Bubba. Patient

We get a call to respond to assist a man in the plant. ALS is probably 4 minutes out.

When I arrive on the scene, I see Bubba is having trouble breathing.

My boss has the pulse ox on him waiting to see if he wants to give O2. The Clerk is standing in the background.

I ask him what the problem is and he struggles to say he has chronic asthma and his inhaler went empty.

I asked him if I could give him some O2.

He said NO and that he didn't like the mask.

I asked if I could use a nasal cannula for comfort. He agreed. I told my boss to give me the cannula and set the O2 at 6L to start

I showed him the pulse ox and said this is how much oxygen is in your blood (72%)

I told him the O2 may not help him breathe but without it he could end up in even more trouble.

We watched as the sat came up to 99%. He tolerated the cannula well. I turned the O2 down to 4L and held 99% consistently.

Out of nowhere comes "Bob". "Is he COPD?" He yells. I said yes. He yells "He needs to be on a NRB at 15L!" I told him to leave as he is no longer qualified to make medical judgements. He gets POd and starts complaing to all of the gawkers about my treatment of the patient.

ALS shows up. He doesn't want the ER. He agrees to a breathing treatment on site. The Medics left the cannula on the whole time.

My Boss sayd that he could be OSHA recordable because I gave him O2 and I should take time in the future to be sure patients need it first.

He uses the pulse ox to determine O2 requirement.

Bob says I didn't give enough.

I felt I was right since he was in distress and COPD.

Whats your take on it?

p.s. Dust please don't jab me for being a Basic.

[JakeEMTP]

p.s. Dust please don't jab me for being a Basic.

LMAO!

I think you did the right thing. O2 can never really harm the pt. Since their pulse ox was going up, then it helped. You did what you thought was best for your pt. Since the ALS crew left him on O2 with the nasal cannula, it must have been correct. Your Basic partners need to review. If the pt cannot tolerate a mask, nasal cannula is better than nothing.

[medic5587]

With COPD patients you should start with lower concentrations of Oxygen first. Unless of course the pt is in severe respiratory distress or arrest, then you would have to be more aggressive in your treatment. I would have removed him from that environment in case it was to due to an irritant/allergy or toxin. Then placed him on nasal cannula at 4 lpm titrate Oxygen to pulse oximetor and entitle CO2. Assessed patient and if appropriate give a nebulized bronchodilator. Was the patient having a asthma attack or was it exacerbation. Was the onset acute? Was there any chest pain/discomfort? Was there any signs of an allergic reaction? What did lung sounds sound like?

[PrissyEMT]

I agree w/ Jake on this one- as a Basic, if a patient can't tolerate high flow O2 by NRB, then you've gotta go to the nasal cannula- you can't make a patient do something they don't want to do, and 6L of O2 is better than no O2.

[Dustdevil]

With COPD patients you should start with lower concentrations of Oxygen first.

Completely disagree. And I suspect you won't find a textbook or instructor who will agree with you. There is absolutely no medical or operational justification for that. If your EMT school taught you that, your school sucks.

Juice, you did just fine. I completely concur with everything you did. No jabs. You're doing what basics do best. First responder. No problem at all with that, as you are obviously doing it well. I do, however, have an issue with your manager delaying care for this patient.

[Nate]

No, your were in the right. I would suggest you give your boss a text book so he can read and understand how to check for proper oxygenation and the use of a pluse ox.

[AnthonyM83]

I told him to leave as he is no longer qualified to make medical judgements.

This might be why he got pissed off and started making you look bad. For the sake of the patient watching the exchange, I would have just explained the situation and told him why it was appropriate. IF he continued, I would point out that he was not qualified (again, for the sake of the patient, so he'd trust me over him) and then respectfully ask him to step away and let you treat, since the treatment responsibility laid on you.

As far as the O2, it seemd appropriate, but I'm not even a 'practicing' EMT, so I'll leave that to the other guys.

[Nate]

Eh, but the pissing match is so much more entertaining.

[medic5587]

I know I am starting an argument that I will not win. I am not implying that you should withhold oxygen because of fear of decreasing hypoxic drive. My point is that there is no harm in titration of the oxygen, if the patient is not in severe distress or respiratory arrest. Let me have it Dusty, I enjoy your knowledge and experience that you bring to this forum.

[Juice]

I know my boss is wrong by trying to avoid a recordable injury at the sake of the patient. He has never worked on a crew. Only has Basic status because it is required.

"Bob" is a volly. He was always trying to prove the instructor wrong or the book wrong and now the NR practical test wrong. I tried to talk to him after that and explained my reasons for the cannula. He said that it didn't matter. Everyone gets a NRB@15L. I asked him about how hypoxic drive works. He said it still doesn't matter. With that, I left.

Bubbas co-worker told me that he usually takes his inhaler 3-4 times a day depending on physical demands.

I did check all the vitals and gave them to the medics.

The environment was actually better where I was treating him than outside of there. No chemicals or fumes.

He said he was having an asthma attack and when I asked on a scale of 1-10 how bad it was compared to his worst, he replied 6. He denied any chest pain, dizziness or any other symptoms. I didn't get far enough to get the lung sounds as ALS showed up so I let the pros do their thing.

I just posted this because I don't want to start second guessing myself at a patients expense.