I Feel very strongly I was right, give my you thoughts.

[ncmedic309]

Sounds like the paramedic is a spastic idiot...that patient needs high-flow oxygen...

[Callthemedic]

I think there's a mechanism of hemodynamic tone in hyperventilation but I don't know of any contraindications of oxygen.

Work it through.

Can anybody make a connection between the heme molecule on the RBC and the fibrin cascade????

I would go with vaso dilation/constriction........but of course, in that case an NRB would suffice.

Did he have any rate/rhythm/quality?

Very interesting, thank you for posting

[Callthemedic]

From emedicine.com

"At one time, severe hyperventilation was an important component of the treatment of increased ICP. Reducing PCO2 to less than 25 mm Hg has been shown to cause enough vasoconstriction that CBF is reduced to the point at which a high probability exists of developing cerebral ischemia. Therefore, prolonged severe hyperventilation is not used routinely to treat elevated ICP. Brief periods of severe hyperventilation may be used to treat patients with transient ICP elevations due to pressure waves or in the initial treatment of patients in neurologic distress until other measures can be instituted. "

As the co2 is restored a rebound effect vasodilates.

Vauge, I know, but that is all I can think of.

[chbare]

Callthemedic, I do not know of any research regarding oxygen and the clotting cascade. I know there are studies that actually indicate oxygen can be helpful in patients experiencing hypovolemic shock. I think the mechanism is related to the inhibiting of nitric oxide in peripheral tissue, (peripheral capillary beds) that causes shunting and increased peripheral vascular resistance. Studies done on hypovolemic rats indicate this action can result in better perfusion of vital organs. This action is in addition to the sympathetic response to hypovolemia. I can PM you the research if you want to mill it over.

Take care,

chbare.

[Scaramedic]

I know this is semantics but I think I need to point this out.

Callthemedic you made a statement and the quoted an article about the effects of hyperventilation in trauma cases. The original question was not about ventilating the patient. Hyperventilation is excessive ventilation, be it by BVM or the patients own respiratory rate. The intervention here was an NRB @ 15LPM. This case if anything would be about hyper-oxygenation, but I do not believe that at 84% hyper-oxygenation is going to be a problem. An arguement can be made that there is not much difference in the rebound effect between hyperventilation and hyper-oxygenation, like I said its probably just semantics.

But you did make a valid and interesting point. =D>

Peace,

Marty

:thumbleft:

[Asysin2leads]

Just to throw my vote in the ring, you did the right thing, the most important thing was the 02 sat at that point. As for the medic, to quote Arnold Schwarzenegger in 'True Lies', I have no idea what the crazy bitch was on. In fact, I would think you would want more oxygen for a patient on blood thinner, as they would lose hematocrit faster from a wound, but anyway...

Here is your revenge. Go to the ER where this patient was taken. Find who was the attending physician on that call. Then, with big ol' innocent eyes, say "Excuse Mr. Doctor, but ummm, I was on a call with Paramedic Crazyasaloon the other night, a stabbing victim, and I thought that I should put the patient on some high flow oxygen 'cause their sat was 84 and the were bleeding profusely, and she said not too because the patient was on a blood thinner. Why was that?" If all goes according to plans, the doctor should turn a pretty shade of red and then go make a few phone calls.

[Callthemedic]

Callthemedic, I do not know of any research regarding oxygen and the clotting cascade. I know there are studies that actually indicate oxygen can be helpful in patients experiencing hypovolemic shock. I think the mechanism is related to the inhibiting of nitric oxide in peripheral tissue, (peripheral capillary beds) that causes shunting and increased peripheral vascular resistance. Studies done on hypovolemic rats indicate this action can result in better perfusion of vital organs. This action is in addition to the sympathetic response to hypovolemia. I can PM you the research if you want to mill it over.

Take care,

chbare.

I always want to mill it over.

If you have a link that would be great.

[Callthemedic]

I know this is semantics but I think I need to point this out.

Callthemedic you made a statement and the quoted an article about the effects of hyperventilation in trauma cases. The original question was not about ventilating the patient. Hyperventilation is excessive ventilation, be it by BVM or the patients own respiratory rate. The intervention here was an NRB @ 15LPM. This case if anything would be about hyper-oxygenation, but I do not believe that at 84% hyper-oxygenation is going to be a problem. An arguement can be made that there is not much difference in the rebound effect between hyperventilation and hyper-oxygenation, like I said its probably just semantics.

But you did make a valid and interesting point. =D>

Peace,

Marty

:thumbleft:

No offense at all taken, thank you.

Everything any of us say should be open to criticism, IF it is done in a respectful, thoughtful way.

To tell the truth, I got target frustration on the heme and sort of forgot it was an NRB :roll:

Anyhoo, it was straw-clutching.

I think you should ask the paramedic in question why they thought this way in the same considerate way.

[Dustdevil]

Callthemedic's point was about the only thing I could fathom even being remotely relevant as I was pondering the physiology in my head. Oxygen is a vasoconstrictor, even without hyperventilation. However, that is hardly relevant in this context at all. There is no interactive relationship that I am aware of between oxygen and anticoagulants. And vasoconstriction is exactly what we use to treat and prevent epistaxis, so that's not a problem.

Maybe the medic was simply using her cookbook brain to classify the nose wound as a "head injury?" :?

If so, she was certainly ignoring the patient's key issues to focus on a red herring, totally disregarding the patient's obvious perfusion and oxygenation deficit. Looking for zebras in a horse stable.

But even then, wtf does that have to do with the anticoagulants? Sounds to me like she's an idiot who just put 2 plus 2 together and came up with 7. :roll:

I agree with Asys. Go to the ER doc and push the issue. Have her arse written up, and hopefully decertified, both for her ignorance and her unprofessional behaviour. I can almost guarantee you that she is badmouthing you and hurting your chances to ever get moved up to EMS. Politics are a bitch. And, of course, if she happens to be the supervisor's girlfriend or management's golden child, then you're just screwed no matter what you do.

[weasel 108]

Next shift, please punch said medic in the head, and scream "PRPG says your an idiot". Thanks in advance,

PRPG

I could not have said it any better. Right on brother.