Was I wrong?

[weasle]

My instructor told me that everybody gets oxygen.

Even if they break an arm, they get oxygen.

If his pulse ox was that low it certainly couldn't hurt.

[xselerate]

My instructor told me that everybody gets oxygen.

Even if they break an arm, they get oxygen.

If his pulse ox was that low it certainly couldn't hurt.

Yes, I have heard of this before. It's called EMR, Emergency Medical Robot. Give everyone O2, don't bother to attempt an assessment of their perfusion...

Anyway...

Here are the people involved.My boss has the pulse ox on him waiting to see if he wants to give O2.

Respitory distress is one of those things you would give oxygen for though... but many people seem to be excessivly hung up on pulseox readings. I don't think it's really neccessary on a basic level. Sure it's nice but not really neccessary. If you got a reading of 98 on this patient would you with hold oxygen? I wouldn't. Let's not forget that pulseox devices are machines and on a basic level we're not even really taught the science behind it... and machines break and need calibration from time to time. I have a far better idea to replace a pulseox on a BLS level.

Look at your patient... feel them... how is their peripheal perfusion (fingertips), how is their central perfusion (lips), are they sweating or diaphoretic? If you follow your basic assessment (skin color, temperature and condition in the C step of your initial assessment) you will have all the information a pulseox will give you. You need to get that information through your assessment regardless of having a pulseox or not or being a medic or emt.

[ffpm41]

Good job, your boss needs to learn to treat the Pt not the pulse ox.

[Ridryder 911]

My instructor told me that everybody gets oxygen.

Even if they break an arm, they get oxygen.

If his pulse ox was that low it certainly couldn't hurt.

Did you even read the above posts ?... I would probably not say anything, might review my textbooks and demad my money back from the school. Your instructor appearantly did not instruct.... it is a shame that this still continues. This is why EMT's have such a bad reputation.

R/R 911

[jmac]

ok,

my take on this, juice, i think you did everything right, your boss did not take into account the issues with SPO2, arthritis, peripheral shutdown in more advanced cases, and enviornment as in if it was in a factiory there may be machinery running giving off excess carbon manoxide, which as all of you know will not show true SPO2 reading.

as for COPD, the way i was trained is that asthma is not COPD..chronic obstructive pulminery disease but COAD, chronic obstructive airway disease, no prob with difusion but with getting air in and out due to mucus in the bronchus/bronchiolei and it is made worse by the pt getting worked up so juice in my humble opinion you did everything right, as much as possible to relax the pt, then titrate down to hold.

if you had done wrong, i am sure the ALS crew would have let you know in not too subtle a manner :twisted: :twisted: :twisted:

well done.

my two cents worth....be safe.

[Katiebug]

Sounds like your boss likes to treat the pulse ox instead of the pt. If someone is having trouble breathing, they should get O2 regardless of what the machine says. The pulse ox is handy, but it has its place. I would trust my own eyes and the pt more than the machine.

Bob is a retard. If he questioned your methods, he could have done it quietly and in a conversational tone. I guess his ego is more important than the pt.

[Callthemedic]

Hypoxic drive is a concern of end-stage COPD only. These are patients that have chronic high Co2 levels and are what you think about when you think COPD. Their sytem has long been ignoring CO2 levels to affect ventillatory drive. These patients will have obvious barrel chests and "clubbed" finger tips in any end-stage process that is a concern for hypoxic drive. End-stage COPD patients will already be on O2 and probably smoking a cigarette through thier trach or stoma. Auscultation is a dead give away. All you would get is pretty much crackles and you wuld be moving your stethescope all over to try and get a well defined breath. The cyanotic appearence of nailbeds and mucosae will be normal for them.

Your asthmatic on the other hand would have appeared more "pink".........well, hopefuly still a little pink anyway. I think an appropriate course would have been a nebulizer with Albuterol/nss via NRB. An asthmatic responds to the air in his enviroment. You could have relieved his bronchoconstriction and his hypoxia all at once. Just remove one of the one-way valves and stick one end of the neb in the hole. Tape the other end of the neb "T" and your good to go. You would need to have an adapter or another gas source for the neb.

Taking a sat is a dreadfully inaccurate science. Something as simple as a soiled finger can throw it off. Auscultation on the other hand can tell you the reason for the dyspnea. If the wheezes are pronounced that is good, if they are decreased that is bad. One means air is moving, no matter how poorly, and the other means you had better have a beta agonist via ET tube or venous handy because the droplets from the neb will not reach much tissue.

You observed the dyspnea and the pulse ox and you treated the patient giving him some level of comfort and preventing him from stressing into ventillatory collapse. You got him to the ER better than you found him. I know you weren't holding you breath waiting for my response, but I don't think the O2 was the issue. His airway was narrowing and he was freaking out. He breathes harder and harder, further irritating the airway. Neither O2 or Co2 is in balance but one only needs 5% of the O2 they inspire at rest. On the other hand, you need to get rid of all your Co2 in that same volume. If you have a disease process they are still directly proportional.

Anyway, can anybody come up with a patient for which O2 is contraindicated in the prehospital setting? Demand for it goes up during stress to the tissue's metabolism. Damaged cells can consume more, right?

Gawd, I wrote a frickin' paper. I just like the pulmonary stuff because I used to be a CRTT.

[Ace844]

:shock: 8) IN SHORT...IF YOU HAVE THE GREAT LACK OF LUCK WHICH PRESENTS YOU WITH THE RAREST OF COPD PTS WHO SHUTS ( I.E.: BECOMES APENIC) DOWN FROM YOUR O2 ADMIN.. WHAT'S GOING TO HAPPEN NEXT?!?!?! :shock:

THEY ARE GOING TO GET ENTUBATED AND RECIEVE WHAT OF ALL THINGS??????

O2 !!!! WHO KNEW!!!! :shock: :shock: :shock: :shock: :shock: 8)

As with most things, common sense should be a more common virtue.... :roll: :shock: 8)

out here,

ACE844

[emt123]

I also agree with everyone, as protocol in Pa, it is suggested to get a COPD patient at between 89-95%, any more O2 will actually create more difficulties in the COPD patient. You did the right thing. Starting with the nasal cannula would have been my second choice (you tried NRB first), and would have tried coaxing the patient into wearing it, atleast until his sats came up, but no harm done on your part with the nasal cannula, you got what you were hoping for out of the patient.

[firefighter523]

Absolutely, You give him a mask, make him more aggitated, he breathes harder, aggrevating his already worsening breathing prob. If he doesn't want a mask, you IMPROVISE, ADAPT, and OVERCOME. Put him on a nasal with the highest amount you can give him. I agree with ACE, even if you knock his drive, and he becomes apneic, then YOU BREATH FOR HIM. It is NOT all the time text book. S#$T happens right!! You did a good job, in my opinion, and apparently in the medics, because they didn't complain.