I Feel very strongly I was right, give my you thoughts.

[miniemt]

As a basic interested in learning more on how to be a better basic and going forward in my education, I have tried to do some ride along with the 911 crews where I work. (For my company all new basics work bls transport trucks to start with, then we move up the ladder, to a als transport truck, after you have shown yourself you get the chance to work on a als 911 truck.) I have moved up the ladder rather quickly in the short time of my employment, from a bls transport to a als transport within 3 months. It usually take 6 months or longer.

Okay back on track of what is going on. I have been doing some 3rd party ride-a-longs with my co-workers on a 911 als truck. It is my strong belief that one of the important things about being a good basic is to know what your medic needs for the best possible pt care.

We had a call for a stabbing victim. Pt had been stabbed twice in the abdomen, once on the forehead, arm, neck, & leg. Everything was great until we put the pt in the back of the ambulance. I climbed into help the medic which is what I was suppose to be doing. While the medic finished her assessment she told me to put the pt on O2. I grabbed a NRB and placed him on full flow 15 liters. The medic went nuts on me. Told me the pt was on blood thinners and I needed to learn my place. Pt had a SPO2 of 84% before placing him on a NRB. She had me take pt off of the NRB and start him on a NC @ 3 liters. On the NRB pts O2 was at 98%, I was not allowed to find out what the level was on the NC.

The other basic working with us the medics usual partner told me when they took the pt into the ED, the 1st question they had was why the pt was on a NC. He told them to ask the medic.

I still consider myself a rookie since I have only had my basic a little less than a year. And I know I have allot to learn. So my question is, what if any are the reasons you would not put a pt on a NRB @ 15 liters due to them being on a blood thinner? (There was no history of COPD).

I am not saying I am not capable of messing up, but I don't see where I did, if so can you please explain so I know in the future.

Mini

[jmac]

to be honest mini it baffles me too, if it was me there you would get a thank you very much, but the medic may have had their reasons, i cant for the life of me see them but they may have, dont dwell on it too much...lifes too short :wink:

[hfdff422]

High flow O2 for all who can tolerate it, that is #'s 1-20 in how to be an EMT (OK- just #1). My only recommendation is to ask "what flow rate" prior to hooking up a patient when you are working with a new medic. I think that is a little odd myself, but I am just a dumb ol' B, so mabye rid or dust can fill in the blood thinner question.

[Guest DELETED]

DELETED

[medic001918]

There's no connection I can think of between being on a blood thinner and high flow O2. If the patient is a stabbing victim that has abdominal and/or thoracic trauma along with a decreased pulse oximetry reading then they are going to get high flow O2. More importantly, it would be a good time to listen to lung sounds and start looking for the cause of the decreased reading. It could be anything from hypovolemia, shock, dirty/bloody fingers, aspiration (due to the facial trauma) pneumo, respiratory insufficency, etc. It doesn't sound like you did anything wrong. If there is a connection between being on a thinner and high flow O2, I'd love to hear it.

Shane

NREMT-P

[tinman694]

Course we have some medics here who put the pt. on NC @2lpm who are in resp arrest....but that is only because 'they might start breathing again' which would require actual work.

Sounds like someone who didn't know what they were doing and started yelling at their lower level partner to cover incompetence?

I personally give it to them in the highest form the pt. will accept it. Hypoxic drive be damned--if they stop breathing it is just another chance to tube em'.

(oh, and I am a paramedic too)

Flame on!

[Dustdevil]

[Scaramedic]

Wow, ummmmm, yeah... :?

This is a new one for me too, I have never heard of complications secondary to oxygen use with blood thinners. I even googled several things, oxygen and blood thinners, oxygen and coumadin, side effect of coumadin with oxygen, heparin and oxygen, etc. I found no articles supporting the Paramedic's hypothesis. In fact, every article talked about the benefits of oxygen use in both medical and trauma patients on blood thinners. So I am also at a loss of what he was thinking.

My only question is this, has the Para had a recent head injury? icepick lobotomy? ingested a large amount of lead paint lately?

In my opinion you did fine, oxygen was a proper intervention on this patient.

Peace,

Marty

:thumbleft:

[chbare]

Miniemt; I think I know the answer to your question. High flow oxygen can dry out the mucus membranes of nasal and oral cavity, this could slightly increase the risk of nose bleed. I would not want a nose bleed to cause airway problems for my patient who has been stabbed multiple times and may already be in respiratory distress. Oh man, I just could not live with causing more blood loss from a small nose bleed on a potentially hypovolemic patient by giving them high flow oxygen. :? (Please note: lots of sarcasm and humor intended.) This is the only possible answer I can come up with. The human brain never ceases to amaze me.

Take care,

chbare.

[PRPGfirerescuetech]

Next shift, please punch said medic in the head, and scream "PRPG says your an idiot". Thanks in advance,

PRPG