Was I wrong?

[Ace844]

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.

"EMT,"

Kindly educate yourself first then come back and repost your advice...In fact EVERYONE SHOULD KNOW that one of the goals of 'OPTIMAL PT CARE', is return your pt to their baseline. ESPECIALLY in this pt. population. You should not be using 'BETTY CROCKER #'S' listed in some protocol to bring your pt 'into the ideal range it states, or even to match soem #'s on a pulse ox machine!!!!... TREAT YOUR PT, NOT THE TOYS YOU BRING TO THEM!!!!

Doing this may be harmful in some cases. So kindly try to understand the phys, pathophys, homeostasis, etc...of the underlying disorders [s:3972d72c48]First!!!!!! [/s:3972d72c48]

Out here,

ACE844

[emtbcmvfd]

I think you did everything just fine...for future reference tell your boss that administering 02 does NOT automatically make something an OSHA recordable or an OSHA reportable for that matter...when it comes to my patient care OSHA doesn't even enter into the equation

[emt123]

Ace,

I appreciate your "constructive"?? critism and your view points, but i believe in protocols, and the reasons they are set. I DO agree with you about the bring to baseline, and "optimal care", but too much is dangerous, especially COPD. I have no problems slapping a NRB at 15LPM on any patient i encounter, but with a thorough history obtained "within reasonable patient interaction" is very key in treating the patien; and I would have kept the patient at a level that is both comfortable to themself and myself, i would rather had a patient sats of 92 and breathing, than possibly tubed and walking in the ER bagging them. Working in an AICU i know COPD's and normal breathing O2 sats run between 87 and 94%. Im not in a pi$$ing battle with you, just defending my opinion.

[Ridryder 911]

I think you did everything just fine...for future reference tell your boss that administering 02 does NOT automatically make something an OSHA recordable or an OSHA reportable for that matter...when it comes to my patient care OSHA doesn't even enter into the equation

Okay, maybe I missed something ?.. or failed to see a post about OSHA ?... but, one needs to remember that oxygen is considered a drug/medication so doucmenting is essential.

R/R 911

[Dustdevil]

From the original post:

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.

[PRPGfirerescuetech]

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.

Please punch your boss in the face, for me, then beat him with the pulse oxes you have. Thank you.

XOXO

PRPG

[Ace844]

I agree with most of your statement EXCEPT this part::

i would rather had a patient sats of 92 and breathing, than possibly tubed and walking in the ER bagging them. Working in an AICU i know COPD's and normal breathing O2 sats run between 87 and 94%. Im not in a pi$$ing battle with you, just defending my opinion.

Ok, 92% and breathing always a +, no arguement here....BUT the 2nd part I take issues with is this. If you work in an ICU than you more than likely know that THIS IS EXTREMELY RARE, even more rare that this happens in the instance where it is due to HYPEROXEMIC RESP. FAILURE VS HYPERCARBIC!!! EVEN IF this were to be the case I will refer you to my previous statement of this:

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?!?!?!

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

O2 !!!! WHO KNEW!!!!

Now I'm not belittling you, or getting into the preverbial pissing match, but those statements that you and some other here are both scary and misleading, hence my follow up post above. We have alot of students here, and the nuances in the above mentioned D/O's are important

.."HYPEROXEMIC RESP. FAILURE VS HYPERCARBIC!!!"

Hope this helps,

ACE844

[Callthemedic]

Although I treated COPD pts for 5 years and worked with them from the ER to the last code, I never witnessed or heard of any pts that had their hypoxic drive affected by administered 02. Not a story during breaks, not as an anecdote to a lecture, just therapists rolling their eyes when the protocol would come up.

However,

When your boss or any other paper jockey is leaning over your shoulder they are looking for compliance of endless protocols so they can go back to their paper piles and check the appropriate boxes. Sometimes they know it's bs too. Sometimes all they do know is the appropriate box to check.

The fact is that most know that hypoxic drive isn't even a zebra of diseases, but is more like a magical freaking unicorn that nobody except tech-nerds that drool over collections of medpubs while sitting on the toilet believe in. Even the tech-nerds rarely claim they might have seen one. Facts do not deter the folks that write protocols in their dungeons of wailing and nashing of teeth called office cubicles. They run on fear, not logic. They need magical unicorns to write about to keep their jobs. They must produce boxes to check asap!

What I'm saying is, let them check their box. You give the care that you think is appropriate, but will also get the box checked. My thinking is if it's going to exacerbate, it's sure as hell not going to be from lack of anything I have to give. If that happens, I am wrong. As long as I'm right, the box gets checked.

[emt322632]

You totally did the right thing. As a BLS provider we train to go on assessment over fancy toys. Even if you have the Pulse Ox, and you can see this guy is having obvious difficulty breathing, give him the mask. If he can't tolerate the mask, then it's a cannula.

As someone said, 6lpm is better than no O2 at all.

And honestly, if your boss can't tell when someone is having a hard time breathing, he needs to be refreshed, badly. Also, with the other guy there, if he continued to be belligerent, it would have been fun to have him hauled off by cops...just my opinon, but i like pissing people off so...:-D

[ebemt]

I'm a big fan of 15 on a NRB. However if they refuse switch to a cannula if they aren't in severe respiratory distress. I think you did the right thing in the situation, especially if the medics did not change to a NRB.