COPD Patient

[Ace844]

my thought exactly chbare, even if you did knock out the hypoxic drive while waiting for the two paragods to get there, you should have been able to help that situation as well. good job always give your pt o2!!

madmedic

Not to mention the fact that IF YOU DO SO...YOUR GOING TO GIVE O2 ANYWAY..!!!!!

OUT HERE,

ACE844

[jmac]

i agree with what been said about hypoxic drive and O2 for COPD Pt's, but i think i am missing something here, the first post was about the medic asking why high rate O2 was being given, the way i would look at it is that the Pt was the first crews Pt and they treated as required.

in my humble opinion the first crew on-scene initiates treatment, followed their protocols for the benefit of the Pt, stabilized the Pt so that the back-up ALS crew had a working body to deal with, whats the problem, if the BLS crew mess up (in my opinion they did not), that's why they called back-up for a potentially un-stable PT,

i would go along with what has been said above, it was a medic problem....not a medical one.

[madmedic8522]

ace, LOL....true, very true...LOL

[Guest Beegers]

I had a fight with one of my old partners regarding COPD patients....he kept saying the same thing that COPD patients don't get high flow o2....

Regardless of the fact, I told him that you are supposed to treat what is presented to you, NOT the history. Pt c/o difficulty breathing, you provide high flow o2.

Later on a few weeks later me and one of my coworker friends were discussing how much of an ass this guy was and the shit he's said to us on scene regarding treatment and whatnot...one of our supervisors overheard us and hunted him down to give him a stern lecture. When the ass starting argueing to the supervisor, the supe took him across the street to the hosptial ER and had the ER doc (a friend of the supe) explain it to him....Never heard a peep from the jackass after that regarding COPD patients.

My captain and a paramedic friend tells me the same....High flow o2, just have a BVM ready in case the pt crashes from the o2. But still it doesn't change the course of treatment.

[medic001918]

As far as the oxygen delivery for a COPD patient and hypoxic drive, it takes several hours (I believe there was a study that showed the time to be in excess of 12 hours) to kick in and should not be a consideration for prehospital care.

...this is why i dont like Paramedics... cause they think they are gods and i wanna just kick him in the head.... but yea give us feed back please...

And on to this statement. Like someone mentioned, this guy was an idiot before he became a paramedic. And don't forget that there are just as many paramedics that don't like EMT's because they tend to think they know everything as well. I've seen many new EMT's come in thinking they know it all, have seen it all and done it all...even though the ink isn't dry on their certification yet. As a paramedic, that attitude gets old as well. In this case, you were right. Remember, people who think they know it all happen on both sides of the coin. Give respect and get it.

Shane

NREMT-P

[whit72]

Here is a good refrence, two points that are noted in this article are:

Adequate oxygen should be given to relieve hypoxia. A belief (ingrained from medical school) is held widely that too much oxygen causes significant respiratory depression. Multiple studies in the literature dispute this view. With administration of oxygen, PO2 and PCO2 rise but not in proportion to the very minor changes in respiratory drive.

Supply the patient with enough oxygen to maintain a near normal saturation (above 90%) and do not be concerned about oxygen supplementation leading to clinical deterioration. If the patient's condition is that tenuous, intubation most likely is needed anyway.

Never withold O2

Maybe you could print the article and kindley hand it to your medics.

[medic53226]

You did the right thing by giving the pt O2, and the next time tell the paramedic that you were in charge at the time and that you treated the pt the best you could and how you were taught and that if he would like to let someone go into unresponsive due to lack of O2 then he can do on his watch not yours, and I bet you money he would rather that pt be breathing then not, as for hypoxic drive it will take hours on hours for that to happen, you were not in the wrong for what you did you did a great job and as a paramedic, you did a great job and made that paragod job a hell of lot easier.

[medic53226]

One other thing as the paramedic what he would do for a pt that had his hypoxic drive knocked out ( Intubate ) amazing, the same thing he would have had to do if you would have withheld O2 because you were afraid that the medic was going to eat you. This just really pisses me off when this happens for no reason, just someone is in a bad mood taking out aggression on someone, and tries to use something they feel, wrong to belittle someone.

[Punisher]

As the only RT on this board (so far as I am aware), I can say that in 10 years of medical experience (the last 5 of that as an RT), I have seen ONE patient with COPD had a hypoxic drive issue and it was abrupt onset in the field. Hypoxic drive does not become a serious issue in COPD until the very late stages of a certain subset of patients- your "blue bloater" type classically... Most COPD patients never develop a clinically significant hypoxic drive and those that do, well as other pointed out, are easily managed by either non-invasive ventilation or intubation. The patient we had started breathing on his own in the ED after the doc asked me to bag him on room air. His sat dropped to 88% or so and he started breathing again....

Just as everyone else said, do not let anyone stop you from giving oxygen to someone who needs it. Quite honestly out of the thousands of respiratory patients I've seen, one complication is pretty good odds in my book.

[Spazz3z]

well to start it just bothers me...

we work in a Independent living facility, meaning they live in apartments and we work here as security and when needed EMS... me and bri are both EMT's, no offence to bri but i have two years on him... now if memory serves me correctly but i remember being told no matter what the call give them O2... he's the kicker

Sir whats the problem?

I'm having trouble breathing, and i got very tired walking back to my apartment.

*15 lpm Via NRB*

Calls 911 and they dispatch medics... thats how this happend...

one of my officers escorted the Medics in and stated to me later they were complaining of being here on such a hot day, monday being of all days.... hmmm thanks for a having a great attitude when coming onscene AS*HOLE... this is the same squad that wants to be Unionized due to the fact the part time people and volunteer people have a say in what happens on the ambulance and they are mad cause there is like 4 of them and they always get out voted, so they wanna act like fools... but this is me venting and thank you for all your confidence... i knew i was right i was mad cause he pulled that crap in front of a PT and made Bri look at me like oh crap we're in so much trouble...