When will O2 truly help?

[Chief1C]

Not that it matters, but I have a number of early oxygen delivery units, suited to various duties dating back over a 64 year period. All but one have D-size, steel tanks; the other has two tanks that are similar in size to a jumbo D. The H&H, "Carbogen"; Carbon Dioxide and Oxygen.. That is one seriously heavy device, wooden and steel case. I tell ppl the H&H stand for Heavy & Hernia.

Edited December 30, 2009 by 4c6

[Spankymedic]

Before I begin, I have to say something on behalf of all EMTs, who were referred to as "poor BLS buggers...who can't do much else...". EMTs are the cornerstone of EMS, and having served as one myself for half of my 18 year career, am proud to have done so. I've learned more as an EMT than anyone would/could imagine. Being a good EMT has allowed me to become a good EMT-P. And as for "not being able to do much else", well, in my opinion, what else is there to do? EMTs can handle any trauma case presented them, can handle OB/GYN and field deliveries, can treat anaphylactic shock with SUB-Q epi and, yes, oxygen. SCA can be handled with good CPR, airway management/O2 therapy, and an AED. This being said, I think that EMTs can do quite abit. I'm sorry, but I get a bit touchy when I hear that EMTs "can't do much". As a matter of fact, I've read an incredible article written by a state EMS medical director about being "just an EMT", and I must say how impressed I was with his insight...and he's a physician. He went on to say in his article that, in an all "BLS" system, EMTs would be just fine, and I have to say that I agree. OK, now I'll get off my soap box...

Oxygen has been proven to be beneficial in virtually all traumatic/medical matters, and its efficacy remains firm. My personal experience has revealed that the use of oxygen has been beneficial, and has resulted in an improved outcome for a wide variety of scenarios. I'm not going to cite specific instances; however, I will mention that the aforementioned results apply to everything from acute abdomen to orthopedic injury. We have to take into account basic physiology with regards to oxygen use and traumatic/medical maladies. During any insult to the body there is an invariable increase in oxygen usage. This in and of itself warrants the use of supplemental O2. In addition, there have been studies showing an overall decrease in pain and anxiety with O2 usage. This is, in part, due to the widely-known effects of oxygen, as well as the probable "psychological" effect that it has on many patients. In addition to this, it's a well-known fact that oxygen enhances vascular function, and improves overall blood flow.

I've studied oxygenation, and its effect on the cardiopulmonary and vascular systems. The use of O2 on patients who may not be defined as "critical" is absolutely appropriate, and in many cases will be of great benefit. I hope that my input has helped shed some light on the subject.

There's a fair amount of back-and-forth recently about the status of supplementary oxygen for a few high-profile conditions, such as stroke and cardiac arrest. It'll be nice to see how that eventually cashes out, but my personal interest is in the less-discussed fronts. A lot of prehospital providers -- particularly the poor BLS buggers who can't do much else -- tend to use O2 as a panacea, on the somewhat religious assumption that it'll help with almost any ailment.

But when will it actually help? I'm curious in two things --

1. For a given condition, in your PERSONAL EXPERIENCE, have you witnessed either ALLEVIATION OF SYMPTOMS or IMPROVED OUTCOMES following the administration of oxygen? This is obviously just anecdotal, but it's the best we're going to do in many cases.

2. For a given condition, have you seen any rigorous research that supports or denies either of the above?

I'm interested in this to better inform us all about the true indications for supplementary oxygen. It probably goes without saying that someone with dyspnea and trouble oxygenating will improve with high-concentration O2, but it is far from obvious whether the guy with the broken leg will hurt any less, the guy with appendicitis will live any longer, or the woman with nausea/vomiting will feel any better. "Throw on a cannula" may not be all that harmful but we'd probably all rather avoid unnecessary treatment when possible. So -- any thoughts? I'm interested in everything from AAA to Zebras.

I will say for my own small contribution that I've had mixed results giving patients with anxiety and similar psych states low-flow O2 by cannula; sometimes seems to help, sometimes not at all.

[VentMedic]

Before I begin, I have to say something on behalf of all EMTs, who were referred to as "poor BLS buggers...who can't do much else...". EMTs are the cornerstone of EMS, and having served as one myself for half of my 18 year career, am proud to have done so. I've learned more as an EMT than anyone would/could imagine. Being a good EMT has allowed me to become a good EMT-P. And as for "not being able to do much else", well, in my opinion, what else is there to do? EMTs can handle any trauma case presented them, can handle OB/GYN and field deliveries, can treat anaphylactic shock with SUB-Q epi and, yes, oxygen. SCA can be handled with good CPR, airway management/O2 therapy, and an AED. This being said, I think that EMTs can do quite abit. I'm sorry, but I get a bit touchy when I hear that EMTs "can't do much". As a matter of fact, I've read an incredible article written by a state EMS medical director about being "just an EMT", and I must say how impressed I was with his insight...and he's a physician. He went on to say in his article that, in an all "BLS" system, EMTs would be just fine, and I have to say that I agree. OK, now I'll get off my soap box...

Why did you become a Paramedic if you felt being an EMT was more than adequate and so did the medical director?

Do you still work only on BLS trucks?

If you work on ALS, as a Paramedic can you do anything that you couldn't do as an EMT? Any meds that improve BP and perfusion? O2 needs a little help sometimes getting to where it should be.

Edited January 11, 2010 by VentMedic

[JPINFV]

Oxygen has been proven to be beneficial in virtually all traumatic/medical matters,

Citation needed. Heck, in the first year of medical school I've already had an entire lecture on reactive oxygen species, so sorry if I seem a little skeptical that oxygen is the end all, be all, cure all treatment that should be given out like candy.

[Ladybug]

Question on this , Im new to this site so I hope Im posting to right area. I have a question about O2 use, I have Pulmonary hypertension on two Ph meds, the question is, I get chest pains and SOB and found that if I use Cpap or they put O2 on me I feel 100 % better when i get theses s/s. problem is My O2 stats never drop below 94-95% on Room air, but when I get like this heart rate increases to the 120-130's can O2 benifit me with decreasing the heart rate or is it a waste and non benny ? hope I made sense thanks for any help ...Michelle

[tniuqs]

Question on this , Im new to this site so I hope Im posting to right area. I have a question about O2 use, I have Pulmonary hypertension on two Ph meds, the question is, I get chest pains and SOB and found that if I use Cpap or they put O2 on me I feel 100 % better when i get theses s/s. problem is My O2 stats never drop below 94-95% on Room air, but when I get like this heart rate increases to the 120-130's can O2 benifit me with decreasing the heart rate or is it a waste and non benny ? hope I made sense thanks for any help ...Michelle

Michelle Welcome ! Yes you make a LOT of Sense and its my bet a lot of members on this board would enjoy the discussion ... I know I would.

This is a very old topic in this area, (ie Oxygen when will it help) I would highly suggest that you start an entirely different (clink new topic) and then cut copy paste, maybe a title (I have Pulmonary Hypertension so why does oxygen help ?)

This case is most interesting indeed and Pulmonary Hypertension as far back as I can remember, has never been discussed in any detail or a topic un to its own. I sense your not front line EMS or maybe perhaps you a dispatcher perhaps or a past EMT as I suspect it would be most difficult to work on a car with this disability.

WE can learn a tremendous amount from our patients and before they get into trouble and need to call 911 or 999 dependant where you reside.

cheers

[D.P.Gumby]

[...]

Again how can one in the field "Quantify" please note that in Kevkie attachment on the use of thromblytic protocol the target SPO2 ie Keep Sats > 92%. I have yet to see any protocol that does not state use supplementary O2 for any CP or SOB. A better question could be can one PROVE that Oxygen in the field is detrimental, just saying

[...]

Why, yes, in one setting involving SOB I believe I can prove that "high flow" O2 can be detrimental, and quantify the detriment even!

http://www.ncbi.nlm....pubmed/20959284

(ok, maybe not prove, but "support such a claim with evidence" perhaps...)

Edit: when I saw my post I realized the post I was quoting was....eh...rather old. This study wasn't even published in 2009. Apologies!

Edited January 6, 2011 by D.P.Gumby

[tniuqs]

D.P.Gumby' timestamp='1294286246' post='252019']

Why, yes, in one setting involving SOB I believe I can prove that "high flow" O2 can be detrimental, and quantify the detriment even!

http://www.ncbi.nlm....pubmed/20959284

(ok, maybe not prove, but "support such a claim with evidence" perhaps...)

Edit: when I saw my post I realized the post I was quoting was....eh...rather old. This study wasn't even published in 2009. Apologies!

[D.P.Gumby]

Firstly a most excellent find and thanks you, but just to split hairs I stated: I have yet to see any protocol that does NOT state use supplementary O2 for any CP or SOB. perhaps in the documented COPD patients a "target SP02" will be used, in future in EMS (although in the study that was Target SP02 was not identified clearly) That said as an RRT in hospital even back in the dark ages our "written" protocols for COPD was titrate 02 to KEEP SP02 88 to 92 %. Yes I certainly hope that this study finds its way into all EMS .. BUT I hope that the very old school limit(s) O2 flow to less than 4 lpm because all COPDers are hypoxic drive. (just not the case)

Fair enough. I don't think I could get any closer than a protocol which suggest titration.

Point 2: Then again yes O2 can relieve the feeling of SOB as possibly in this case of Pulmonary Hypertension this is a completely different pathology, in fact SOB i.e. shortness of breath is a complaint from the patient not a sign like say cyanosis, nor can SOB be quantified, moreover it is a symptom. If you follow my drift, please lets not scare the bejesus out of LadyBug because with her "post" as she states that despite SP02 readings her Heart Rate comes down, not an apple an orange (but I will let others take a stab at the explanation first ... why as to not be a show off)

Totally concur, I wasn't suggesting that the role of O2 in COPD was anything like the role of O2 in pulmonary hypertension - as you say totally different. As for the mechanism of decreased tachycardia in pulmonary hypertension, I think someone somewhere threw out the idea of release of hypoxic pulmonary vasoconstriction, and that makes sense to me, although I haven't done my research and as such have no evidence supporting that guess.

You did find in the "documented known COPD cases" that high flow was detrimental in regards to mortality morbidity, that was linked to PFTs and previous diagnosis (there is lots walking around undiagnosed, I believe it is becoming more "trendy" with the CHF patient as well to titrate O2 to SPO2 as to just blow back ones hair @ NRM 15 lpm.

Point 3: Way back in 2008 even supplemental 02 (low flow) and link quoted that the post operative geriatric patient (with no prior COPD PMHX) also had an increase in morbidity mortality when low flow O2 was used hypotheses being Staff equated Low SP02 to hypoxia when it was Ventilatory Failure (high PaCo2s)

I don't think I've seen that post-op paper, looks like a good read thanks. Also, you mentioned in another thread that there was evidence supporting a mortality (?) benefit with titrated O2 in CHF, and I a similar idea here. I did some looking but was only able to find one recent article, and it was a very small pilot study looking at oxygen in chronic left ventricular systolic dysfunction. I turned up some older studies (still working on reading them) which were more specific to oxygen in CHF/APE, but nothing newer. Is this new trend based on new evidence that I couldn't find, or old research, or....?

Edited January 7, 2011 by D.P.Gumby