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

[Ridryder 911]

I agree with others has posted..and actually since the patient was on blood thinner an increased oxygenation should had been considered. I however suggest not trying to get the medic into trouble. Although, she appears to be dumber than a brick... you are the "newbie".

Sometimes, you have to pick you battles "wisely". Talk to the physician, and once he concurs with you, then I suggest to talk to the medic one on one. Ask her, the rationale and let her explain.. once she has, inform her that since you were new and learning, that you had discuss with the physician and describe then.. chances are, she will not want to make battles. After you have you were in the right, learn from this.. As you said, you are climbing the ladder.. be careful not to "tip it over".. The medic made a mistake.. you caught it... you know better, she knows better.. Chances are she have might learned something as well...

Be safe,

R/r 911

[Dustdevil]

Miniemt, I am curious as to how you think you might have reacted if the sequence of events had been reversed.

Suppose you had hopped in with the patient and the medic and she had been the one to apply the oxygen instead of you. Would you have questioned here there on the spot about the nasal cannula? If so, how so? If not, why not?

It's a tough situation, and I can't really tell you what the "right" response would have been. I'm not looking to criticise. I'm just wondering how you and other basics would have handled that scenario since we hear so much here about "EMTs save Paramedics," as well as how often those attempts to "save" us sometimes go horribly wrong.

If you find yourself in a position where you actually think you are "saving" your medic, how do you deal with it?

[Callthemedic]

I would react with:

"Since his sat is 85 should we put an NRB on him now?"

If I thought the patient's life was in danger I would say so right there and make them call me off with an explanation. The thing about pulling rank is that I would never do it unless I was advocating for the patient. This is not an ego thing, I must be certain.

Under my breath.........*Whiskey-Tango-Foxtrot?......over*

Just like I would with anybody certed above me, or in a supervisory capacity. I would act respectfully, as if it is still their idea , until I get a chance to talk to them off-line in a more relaxed atmosphere. No patients, or coworkers within earshot and it would be time for point-blank questions. Firm, confident and still respectful.

Then if they were still an A-hole I would take their frigging head off :twisted:

[Callthemedic]

Chbare,

Thank you for PM'ing the paper. I thought this was relevant to the case:

"Experiments have shown that vascular cells and tissues that reduce endogenous O2-. availability (such as superoxide dismutase) are more prone to vascular relaxation, whereas O2-. generating compounds are inhibitory (such as xanthine oxidase) (Granger, et. al., 1986). (4) Finally, when cells are in the absence of hemoglobin or O2-. and are in oxygenated media at pH 7.4 the predominant reaction of NO is as follows:

8NO + 4O2 + 4N2O4 à 6NO2-. + 2NO3-.

These reactions explain the effects of oxygen therapy during hypovolemic shock. If oxygen is able to decrease NO concentrations and ultimately inhibit the vasodilatation effects of NO then vasoconstriction will occur"

The media is too alkaline to be a good comparison but still, this can only be advatageous from an NO viewpoint.

I would still love to hear the medic's rationale. You never know.

[TTLWHKR]

Yeah, looks like a case that requires oxygen. However, I usually only put people on enough to keep the bag inflated. Like 10.

I've been an NREMT-P for seven years, and an EMT-B instructor for six years. High Flow Oxygen by NRB would have been one of the first treatments for a basic EMT.. or any EMT (CC/I/P/et al).

and with that many stab wounds, they may not want to worry about the fine print, and get some fluid going. Especially with a stab wound to the abdomen w/ anticoag meds.

[Callthemedic]

Yeah, looks like a case that requires oxygen. However, I usually only put people on enough to keep the bag inflated. Like 10.

and with that many stab wounds, they may not want to worry about the fine print, and get some fluid going. Especially with a stab wound to the abdomen w/ anticoag meds.

Yes, as I understand it, the standard for the NRB is enough flow to keep the reservoir inflated opposite inspiration, not 15 lpm. Is that correct?

I think this would help the claustrophobic patient tolerate it better as well.

I would also have thought a lacerated bowel or liver would be more of a concern than the semantics of 02 therapy 101 class

Maybe the basic would be of more use if they were putting in the 2nd line or doing a focused assessment.

[Asysin2leads]

Look, let's stop wasting time discussing it.. She was nuttier than a fruitcake. The motor was running but no one was behind the wheel. The elevator doesn't stop at all floors. A couple of bricks short of a load. A couple of cans short of a six pack. Looney Toons. Scooters.

[miniemt]

Hard to think of what I would have done if the medic had applied O2 before me. I would like to think I would have in a professional manner asked her if she needed me to locate a NRB just in case she could not have found one. Not sure how I would have worded this. I have learned from working on a ALS transport truck that a good basic knows how to help their medic, and how and when to ask questions. I might have asked her to explain to me the reason the pt was on a NC instead of a NRB. But I know me I would have done this in a professional manner. Correcting another EMT be it a Basic or medic in front of a pt or pt family is wrong in my book unless it is a immediate life threat to the pt. Of course I might feel different after I am no longer a rookie.

As far as the medic goes, she is nuttier than a fruit cake. I have heard from many other co-workers that she does things like this often and is on thin ice.

I did ask my regular partner who is a medic about this and he in return asked the medic I was working with that day. Her answer was you never put a pt who is on blood thinners on high flow O2. But could not explain why. We have voted that she got her medic lic. from a cracker jack box.

Mini

[tddubois]

I agree with what most of us have been saying. BLS workers should never challenge a Medic in front of a patient. Like its been said before, challenges are much better taken in the form of questions asked off to the side afterwards. Medics are more experienced, better educated, and licensed above BLS folk, and are therefore owed the respect they deserve, especially when with a patient.

Medics should not make BLS look like idiots in front of a pt. either. Corrections, and suggestions are all good in my opinion if they are in the interest in the pt. care, but bringing calm to a tense situation is also a part of our pt. care. If you’re a pt, and you don’t have confidence in who’s taking care of you, it just makes the “I’ve been stabbed, I’m going to die” syndrome worse. A lot of EMS seem to loose sight of this after enough time being on the road.

Now obviously this does not mean that medics are infallible. You saw big blood so you thought big 02, that’s what basics do, take care of the basics: 02, plugging holes, lifting and moving… all the things that your trained to do so that the medic can worry about what he’s trained to do, this means you get the ultimate job (the patient to the hospital) done better and faster. It makes the medic look good, and that success is passed down to you. In all reality I’d say your right to be wondering what she was thinking, and right to question her on that, but in the moment BLS (in almost every situation) should just do your job, then what the medic asks, then get in the front and drive.

Sounds like you weren't in the wrong.

[Callthemedic]

So..........There really is someone who went through both basic and medic levels, got certed as a paramedic and doesn't know that oxygen has no contraindications??

Not only am I being asked to believe that, but now you are saying that they didn't go home and do some of that there fancy book learnin' after the case to review skills??

Someone that doesn't know how to use oxygen is being allowed to be a lead medic by the company and the other medics don't speak-up, the supervisor doesn't step in???

See what I'm saying here?

Has anybody else EVER seen such an animal? I think the OP is having some fun at our expense.