ER Doc wanting to remove High Flow O2 from protocol

[medic53226]

I would like your opions on this subject, and any info you might have. In our system one of the doctors, is saying that you should never use high flow O2 on anything. So, He wants the paramedics and emts to show him with medical documentation, that why high flow O2 is needed.

Thank you for your time.

Chad

[AZCEP]

Nothing like a blanket protocol to throw out the baby with the proverbial bath water, eh?

Check pubmed and the ECC 2005 guidelines to start.

[tniuqs]

NEVER EVER------Hmmm ? The old "Never" comment.

Granted there has been recent changes "perspective wise" in some research that indicate that Oxygen therapy may be more detrimental that previously thought, Hi flow O2 therapy can be controversial to say the least: absorbtion atelectasis, toxicity to type 2 cells, and some outcome studies are suggestive that hi levels of O2 are detrimental in CHF......(a very small study) or higer incidents of post op complications of Pneumonia with low levels of O2 in the recovery room.

He wants the paramedics and emts to show him with medical documentation, that why high flow O2 is needed.

I personally applaud this "attitude" it does make one think does it not? BUT perhaps ask this astute MD if one was to withhold Hi flow O2, is he willing to put his licence on the line in a court of law that uses " accepted standards of care" as guidelines ? I think he maybe is just challenging you to use that thing called a brain, conversely my query to your system MD would you put your his suggested Protocol on paper... thanks.

Let us remember in the "old days" we gave BiCarb to a non-perfusing heart, we gave Hi dosage Epi, we hyperventilated head injuries, we used 10 to 15 mls/kg for tidal volumes, we did some crazy stuff that we now know was most likely not to the benefit of the patients...... time and research will tell.

[VentMedic]

It uusually only takes one memo or phone call from your medical director to quiet down another doctor protesting a protocol that your medical director has his name on. If this doc has a problem with this, your MD will probably tell him to petition the Medical Board of Standards (or Review) for his area to attempt to change things. Your medical director is the one backing you up. EMTs and EMT-Ps will not win in arguments with doctors. The ER doc also works with a Medical Director who establishes P&P. He should already be aware of the chain of command prior to making a statement like that.

He can express his knowledge from different research being done and be open to discussion.

For every paper pro you can find 2 con and vice versa depending on how you word your search. A couple papers published usually do not make great changes in the medical field. New equipment may be trialed for a min. of 5 years before going into general use.

The ER doc has the advantage of more diagnostic tools and time to exam the patient. What may present straight forward as one problem may actually have another problem that caused or exacerbated the other.

In the hospital setting, you'll literally have hundreds of doctors expressing their thoughts on how things should be including oxygen protocols. If it is reasonable, their request/order is followed. If they do not want to listen to why their request can not be followed or if it deviates from the P&P(which they will get a copy of) too much, they get a call from our medical director. Usually a compromise is quickly reached. Most doctors will comply to hospital P&Ps for they do not want to be the subject of review by their peers.

[Code 8 Paramedic]

:roll: thats about all i have to say about that

[tniuqs]

:roll: thats about all i have to say about that

Ok Forrest, what kind of Chocolate did you get? :shock:

[AnthonyM83]

What's his logic for this? Low flow O2 works just as well? Got anything else? details?

[Richard B the EMT]

I'll use the polite version:

Opinions are like noses. Everyone has one.

[tniuqs]

What's his logic for this? Low flow O2 works just as well? Got anything else? details?

http://www.emtcity.com/phpBB2/viewtopic.ph...p;highlight=chf

Note Oz medics comments, a interesting thread to be sure, lots of controversy in the research phsiology as of late there is other threads an MD researcher posted in EMT City about CHF and poor outcomes with Hi and lower levels of O2 administration, but this was very small study group to my way of thinking frankly (soory cant find the link) as my connection sucks right now.....or..... I am just lazy too, you pick lol.

If you go to the "CHEST Magazine" website you may find more info in this regard as well.

[Spock]

It seems to me this doctor has things backwards. He is the one with MD behind his name so he should produce research that says high flow oxygen is detrimental and have the protocol changed. High flow oxygen is clearly not indicated for every patient and judgement should be utilized.

I've long felt that the difference in FiO2 between 10L/min and 15L/min is not clinically significant but does empty the tank one third faster.

Live long and prosper.

Spock