Meghan Shannon Posted December 29, 2009 Share Posted December 29, 2009 When I went for my practical exam last week, I was given the scenario that my patient was unconscious and breathing x 28 min, shallow, and labored. I told the assistant to give positive pressure ventilations w/ a BVM on O2. I passed, so I know I didn't kill the guy, but I'd love to know if this was an appropriate intervention or if I should have done anything different. I was hoping a seasoned EMT might give me some insight. <3 Link to comment Share on other sites More sharing options...
fireflymedic Posted December 29, 2009 Share Posted December 29, 2009 Yep - perfectly fine intervention. If they were shallow, he obviously wasn't getting adequate volume, labored he couldn't take in enough anyway, and rapid at 28 - sounds like a good candidate to me ! The evaluators will not fail you unless you perform a dangerous or inappropriate intervention. You passed, performed appropriate interventions, sit back and enjoy the fact you passed before the real work begins ! Link to comment Share on other sites More sharing options...
itku2er Posted December 29, 2009 Share Posted December 29, 2009 When I went for my practical exam last week, I was given the scenario that my patient was unconscious and breathing x 28 min, shallow, and labored. I told the assistant to give positive pressure ventilations w/ a BVM on O2. I passed, so I know I didn't kill the guy, but I'd love to know if this was an appropriate intervention or if I should have done anything different. I was hoping a seasoned EMT might give me some insight. <3 Yes you did the right thing, based on his S/S. Good Luck on your EMS career and hope you go further with your education. Congrats on passing now the real fun begins! Link to comment Share on other sites More sharing options...
melclin Posted December 29, 2009 Share Posted December 29, 2009 I like to take opportunities like that to figure out why it is that it was the right thing to do - its always more interesting just after a 'realistic' scenario. Grab a textbook, or Google some terms to get familiar with a few of the important concepts involved. 'Tidal volume' and 'anatomical dead space' are the things to be Googling if you don't understand them already. I don't don't know where you're at education wise, but the difference between 'hyperventilation' and 'tachypnea'; and 'ventilation' and 'oxygenation' are fundamentally important to understand too. There seems to be a lot of conflict regarding these relatively simple ideas and it is potentially very dangerous for the pt if their EMT acts on a faulty understanding of these ideas. 2 Link to comment Share on other sites More sharing options...
mobey Posted December 29, 2009 Share Posted December 29, 2009 I like to take opportunities like that to figure out why it is that it was the right thing to do - its always more interesting just after a 'realistic' scenario. Grab a textbook, or Google some terms to get familiar with a few of the important concepts involved. 'Tidal volume' and 'anatomical dead space' are the things to be Googling if you don't understand them already. I don't don't know where you're at education wise, but the difference between 'hyperventilation' and 'tachypnea'; and 'ventilation' and 'oxygenation' are fundamentally important to understand too. There seems to be a lot of conflict regarding these relatively simple ideas and it is potentially very dangerous for the pt if their EMT acts on a faulty understanding of these ideas. Great answer! Dead space ventilation is a good thing to consider when assessing the adequacy of shallow resps. 1 Link to comment Share on other sites More sharing options...
funkytomtom Posted December 29, 2009 Share Posted December 29, 2009 Great intervention and congrats on the practical! If your patient has shallow respirations, he/she is unlikely to be properly oxygenating...I know that it seems weird to be bagging a tachypneic pt, but if the respirations are shallow, it is appropriate. As you can see, some very simple questions end up with more complex questions than before, and very little resembling a solid answer. It is a dynamic field and I hope it excites you. Link to comment Share on other sites More sharing options...
medichopeful Posted January 4, 2010 Share Posted January 4, 2010 (edited) When I went for my practical exam last week, I was given the scenario that my patient was unconscious and breathing x 28 min, shallow, and labored. I told the assistant to give positive pressure ventilations w/ a BVM on O2. I passed, so I know I didn't kill the guy, but I'd love to know if this was an appropriate intervention or if I should have done anything different. I was hoping a seasoned EMT might give me some insight. <3 Not a seasoned EMT, but did you try to insert some sort of adjunct, such as an OPA or NPA? Because if your patient was unconscious, he needed to have his airway protected. Edited January 4, 2010 by medichopeful Link to comment Share on other sites More sharing options...
Kiwiology Posted January 4, 2010 Share Posted January 4, 2010 (edited) Oxygenation and ventilation are often confused and the concepts used interchangably. They are not the same thing are infact two different physiologic proceses. The amount of air breathed in is not the amount of oxygen that will reach the brain and tissues. - Air is about 21% oxygen, yet in Denver it's lower (I don't know the exact forula to figure out how much lower) so altitude plays a part - The ability to change pressure inside the thorax is also important; if Stanley my immaginary grey pet elephant sits on your chest you will have a very hard time creating a negative pressure gradient to draw air in as you can't expand the throacic cavity enough. - Just because oxygen is inhailed does not mean it will reach the bronchioles, alveoli, blood, cells and tissues. Any number of obstructions may prevent this - eg choking, hypovolemia, obstructive lung disease/pulmonary edema, carbon monoxide poisioning or a haemothorax. It is also important to recognise that not all the air inhailed will reach the respiratory zone for the oxygen to diffuse out of the alveoli and into the blood. The lungs have what is called dead space either anatomical (bronchi and bronchioles that do not have alveoli and pulmonary capillaries, I believe this is the first 20 or 21 divisions of the bronhcial tree) or alveolar; alveolar dead space is any buggered alveoli that can't exchange gas either because they have collapsed or are full of puss or the marbles I ate for dinner. Dead space is an important concept as about 150ml of air will occupy the anatomical dead space at any one time, this will increase if there is additional alveolar dead space such as in infection or APO/CPE. Let use consider your patient who is breathing, say 30x a minute and his tidal volume is say 250ml. AVR = RR x (TV-DS) so 30x(200-150) is an AVR of 3,000ml/min .... nowhere near adequate considering only 21% of that is oxygen so this poor guy is only getting about 630ml of air a minute heck no wonder he passed out! In theory (I am not a pulmonologist) if you are bagging say 10x a minute and your BVM has a volume of say 750ml you should have an AVR of 6 litres a minute, or about 1.2 of oxygen Shallow breathing (at any resp rate) is nowhere, nowhere near as effective as normal or deep inspiration. Also remember taking the opposite approach and bagging the snot out of someobyd will not help them much either, but I won't ramble on about hyperoxemia and pH washout. Do hope that helps, this sutff is interesting. Edited January 4, 2010 by kiwimedic Link to comment Share on other sites More sharing options...
chbare Posted January 4, 2010 Share Posted January 4, 2010 Some good points; however, the FiO2 does not change at higher altitudes. The pressure decreases, but ~21% of that lower pressure is still oxygen. Take care, chbare. Link to comment Share on other sites More sharing options...
melclin Posted January 4, 2010 Share Posted January 4, 2010 (edited) As a point of uninteresting trivia... Oxygen concentration does change with altitude above the turbopause because the thinning atmosphere reduces molecular interaction, allowing the the elements to stratify based on molecular weight. I was talking about altitude related physiology with an atmospheric science major friend of mine after reading Into Thin Air and she broke out that gem after I stated emphatically that FiO2 does not change at altitude, to which I replied with a barrage of Doritos. ...Prrrobbbably not going to affect Denver though... Edited January 4, 2010 by melclin Link to comment Share on other sites More sharing options...
Recommended Posts