JPINFV

(Assuming that the patient isn't acting) Probably not, actually. Just because the heart is hypoxic (secondary to a coronary blockage, for example), doesn't automatically mean that the person has a problem with O2 saturation, especially early on. Based on the patient skin signs and BP (sure, its elevated, but really not that much), the patient doesn't appear to have problem pumping blood. Breath sounds are clear and equal, along with no medical hx (i.e. lung cancer, COPD, pulmonary HTN), so it appears that both lungs are functioning quite well. SOB most likely secondary to anxiety or localized hypoxia. From a BLS prospective, it looks like it might be a CVA or possibly an MI (grant it, skins are great for an MI and the neuro problems are more associated with CVA). Both of these are localized hypoxic event. Both of these would, except when stroke volume starts to decrease during an MI, have a great spO2 since cardiac output is higher (for the non-medics out there, cardiac output=heart rate x stroke volume [the amount the heart contracts]). Both of these patients get high flow O2 so that if any blood gets past the clot it will be fully oxygenated. O2 also carries the placebo effect. "Well, they're doing something for me [high flow O2], so I should start to feel better..." They feel better, the anxiety level decreases. Parasympathetic nervous system kicks in lowering the heart and breathing rate. This lowers the demand for O2 (less ATP used up...) and saves muscle. A low spO2 is helpful. A normal spO2 doesn't really rule very much out, though.

pulse ox=oxygen saturation. pulse ox does not = [cellular] respiration Interfere with respiration and the pulse-ox will give you a valid saturation. Sure, the RBCs might be fully saturated with oxygen. That doesn't mean the cells are able to use the oxygen or that there isn't a blockage someplace.

You know, I remember one of the ones on Traumacentral. I was all pissed off about it because I was a wet behind the ears basic (pet peeve: EMT-P, EMT-B both EMTs. I'd rather be called "just a basic" then "just an EMT") and thought the same. After working part time (full time college student), I realize there is a problem. Ok, preface, I work for probably the world's worse IFT company. Hey, they pay the most and are willing to work with my schedule. (Dust, read the whole post before commenting, we all know you're views on IFTs) There is a problem with a basic who think they can do discharges with a patient on a albuterol breathing treatment because they didn't start it (medico-legal/scope). There is a problem when a basic call for an ALS unit when they are 0.4 miles away from one of the best hospitals in the area (500+ beds, ER almost never closes), thus delaying both ALS and definitive care (protocol education). There is a problem when basics think that the trendelenburg position is great for a patients BP but has never heard the term "starling effect." (education problem) There is a problem when the basic training is 120 hours, mostly based on trauma (come on, most of the work is medical to begin with). Even then, I could have sworn I learnt over half this stuff as a boy scout. (education and emphasis problem) There is a problem when basics want to use [insert random gizmo, pulse ox is the favorite here] yet have no idea what would give you a false reading and/or think it is a hypoxia detector (grant it, based on a recent post, this last one is popular with ALS at times as well [*cough* cyanide affects cytocrome C, not oxygen saturation]) I personally, feel educated enough for BLS. By educated, I mean almost 3 years of college level courses [biochem, genetics, upper division cell bio, upper division physiology, etc] that backs up the very basic and almost useless information given to me in my basic class. I know that I've diverted to closer hospitals because of my education or hospital volunteering experiences. Unfortunately, from what I have seen on this and other boards I seem to be the exception rather then the rule for BLS. If I had my way, EMT-Basic would become EMT-IFT. No lights, no sirens. Just a van, a gurney, a tank of O2, and some isolation supplies. This is the minimum standard to take granny for dialysis or do that hospice discharge. EMT-I is the new EMT-Basic, minimum staffing level on an ambulance. Someone who can do more then say, "Here’s a NRB." If California had widespread use of intermediates, I would have highly considered it. Unfortunately, most parts of California is basic or paramedic (and where I am, paramedic=fire department).