Was I wrong?

[JoelEMT]

Juice,

Sounds like you did fine and more or less everything by the book. The only comment that I would make is more of a suggestion than anything. --> It sounds like you got most of a history before your ALS arrived but you stated that you didn't get around to checking lung sounds. Now as far as I'm concerned, Lung sounds fall under your ABC's at Breathing. esp. if your pt is having resp. distress. As a responding backup person I would prefer to know what is ACTUALLY going on in the lungs (aka lung sounds : wheezes, crackles, little/no air entry etc. ) vs. knowing that the pt has a hx of asthma.

If your pt is an asthmatic, they will mostly likely tell you (if they can) that they are having an asthma attack. if they have COPD you might have to pry a little more.

Good questions to ask someone with a severe asthma attack or any other severe resp distress for that matter is whether or not they have been intubated before or if they take multiple meds for their condition.

Good Work and keep it up in the Future. Don't let politics compromise pt care.

[Nate]

Another little trick for you. Ask the patient to close his eyes, take the NRB and crank up the oxygen, hold the NRB just above the face of the patient and ask him to take long deep breaths with you. The mask isn't "on" him, but he gets more oxygen and might be willing to accept that mask after he is calm.

Also, I was waiting for someone to say something about this, but if the patient is normally using an inhaler and it ran out, then a breathing treatment would be of benefit. :wink:

[Dustdevil]

So would you be wrong if you considered this a COPD patient? Explain your rationale...

Hmmm... In the context of treatment decision making, I would consider it wrong to place any meaningless label on your patient. We are to treat our patients as individuals, not as diseases. I have always felt that respiratory was one of the weakest links in EMS education here. And it really is. Giving people broad labels like COPD without sufficient education to fully understand them is just plain dangerous, as evidenced by this scenario. But even if you do fully understand the pathophysiology, such labels don't add anything significant to the pre-hospital picture.

[THUMPER1156]

:occasion5:

[tinman694]

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.

Cannot resist--

Why is it that every time I bring in a COPD on HF02 the recieving nurse usually freaks out then?

I agree with Dust--why is it there is no medical justification--but people still do it--

Sort of like using the non word IRREGARDLESS---It makes me mad.

[Dustdevil]

Why is it that every time I bring in a COPD on HF02 the recieving nurse usually freaks out then?

Probably not a very experienced or educated emergency nurse. Nurses come out of school with a more long-term holistic approach to patient care than we do, as it should be. They get very, very little education or training in immediate, emergent concerns which deviate from the norm. That is why there are two completely different professions. Completely different concerns.

[Ridryder 911]

Ditto what Dust said as well, you need to remember like basics, nurses are not taught on how to secure the airway as well. Hence.. the worry factor of knocking out the respiratory drive. As well, many are again looking at long term respiratory and ventilator care as well.. when working in a unit, trying to wean a chronic lunger off the vent for several weeks, you can imagine how you are not anxious about placing another one on one.

I got into a debate with Clinical Nurse Specialist about this several year ago, she was discussing the pearls of high flow and how horrible it was that we would knock their drive. After several minutes of discussion (in which I understood her point, although did not agree) I pointed out that you allow a patient in respiratory compromise, to become more tired, increasing metabolism, becoming more acidotic, and increasing risk of hypoxia with all its complications (ectopi to AMI, to cerebral hypoxia). Which would you prefer.. being difficult to wean off the vent or multi organ failure and damage ?.. then still have to place on the ventilator, with very low probability of coming off... she did not reply...

[Emiztish]

Could you expand on how much time is involved in knocking out someone's drive? Would it really take hours for this to happen? In my area transports are average 5-8 minutes plus on-scene time... could hi flow oxygen hurt the patient in that time?

[Just Plain Ruff]

my understanding is that it takes a while to knock the respiratory drive out. But I am sure others can shed light on that.

I also remember that if the patient is not a true copd patient that you can't knock it out. Again maybe others have info I might have forgotten.

Ive transported a "COPD" patient for 40 minutes to the nearest ER on high flow and not a twinge of knocking their resp drive out happened. Patient kept breathin

[Ace844]

This should answer most of the queries and questions raised here...

[web:aad69096a7]http://www.emtcity.com/phpBB2/viewtopic.php?t=2657[/web:aad69096a7]

Hope this helps,

ACE844