Was I wrong?

[Callthemedic]

A cannula is dependant on breathing pattern and turbinate patentcy.

If the pt has a cold you could actualy rest it on his bottm lip as a last resort. I have done this with the most difficult 02 refusals with a rise in sats.

With the pt refusing the NRB and approaching resp inadequacy, doesn't this begin to cross over into assumed consent? After all, clostrophobia doesn't have as high a mortality rate as resp failure, right?

After informed consent of a pt on the + side of LOC, you have no choice but to give him what he would tolerate anyway.

[Ace844]

A cannula is dependant on breathing pattern and turbinate patentcy.

That's classic..Turbinate patency...."ERRR..Yeah doc, I woulda put him on O[sub:33ac008e25]2[/sub:33ac008e25]. cept his turbinates weren't patent, and he didn't like the mask thing..ahhh, so i was like oh-well!!!...Why, is that wrong?" :shock: :shock: :roll: :roll: 8) :!: :!: :!: :!: :!: :!: :arrow: :!: :!: :!: :!:

[Ridryder 911]

Actually it should be to see if the turbinates are patent, which you can easily perform by having the patient place a finger on the nostril & occluding it & then breathing through it. Then repeat the other side

Usually, I don't worry about it unless hx. of fxr nose, major septum defect or large amount of nasal secretions (boogers) ... :wink:

R/R 911

[Ace844]

Actually it should be to see if the turbinates are patent, which you can easily perform by having the patient place a finger on the nostril & occluding it & then breathing through it. Then repeat the other side

Usually, I don't worry about it unless hx. of fxr nose, major septum defect or large amount of nasal secretions (boogers) ... :wink:

R/R 911

I was being ironical.......err...fascetious.... :shock: :arrow: :!: whatever :wink: 8) U tha man RID

[Callthemedic]

Actually it should be to see if the turbinates are patent, which you can easily perform by having the patient place a finger on the nostril & occluding it & then breathing through it. Then repeat the other side

Usually, I don't worry about it unless hx. of fxr nose, major septum defect or large amount of nasal secretions (boogers) ... :wink:

R/R 911

Good points.

Facial fxs causing swelling, allergies(secretions), bleeding, polyps and yes........*sigh* boogers.

[SMSEMS]

First and for-most you did the right treatment YOUR PATIENT is telling you they do not like the mask a lot of Asthmatic/COPD Pt's do not like the mask it makes them uneasy in which will make them not breath right in turn will cause MORE problems than what you are currently dealing with. 2nd 99% of COPD Pt's are very at ease with spo2 around 93-95% they like it if your pt was comfortable with a mask by all means give it to them. In closing tell " BOB " to chill take a pill and go fishing somewhere else

[angelbaby1414]

[/font:7648ba1904] Juice,

You did exactly the right thing. Never withhold O2 from a patient, even if the pulse ox says 99%, if your patient says he is having difficulty breathing. And EMT-B curriculum states that you always apply the NRB unless your patient will not take it, than you use the canulla. As for withholding or titrating O2 for a COPD patient, WRONG! unless you have a considerable drive to a hospital (like an hour or more). Good work!

[COCOEMT]

You did the right thing. I a pt will no tolerate a mask some O2 is better then none. I don't understand your bosses reasoning for wanting to get a spO2 reading first because as you said the pt was in obvious distress it should not have mattered what his spO2 was. That should be used as a guide only anyway just to make sure that your treatment is actually working. As an ems first responder you do not have to worry about knocking out a pt breathing because you give him "too" much O2 it takes hours to actually do that. And regardless if he stops breathing because you gave him O2 you just breath for him anyway.

Also asthma is a COPD.

[ffmedic9588]

First thing first great job Juice, well done. I think your boss needs to go back to school. I think there is alot of great info in discussion from the vets (Dust, Rid, and others) I am 6 years in and I have never heard once of a pts hypoxic drive being shut down due to 100% O2. 6 years ago when I took my EMT-1 (Basic) my instructor told us "100% for resp distress, if you knock out there hypoxic drive you know what to do to control it." I am not saying I would want it to come to that but it is a true statement so high flow is good and I would have done the same thing you did. Relax and don't worry about it.

[asrnj77]

"Bob (not his real name). EMT-I99 expired last year after 10 years. Took Basic with me and failed NR Cardiac twice (no certification right now)."

I would be concerned that Bob's I/99 (as in 1999) expired after ten years :scratch: