The other side of the NH coin

[itku2er]

Ok here is a situtaion i was confronted with at work......

I had a 67 yo female resp distress sats were 69% on 10 L by nc.....b/p 210/110 p120 resp 32 t 99

she was cyanotic and sweating....911 was called and the Squad that arrived to transport the resident to the ER ....shows up and guess what....knowing this lady was a full code and in RESP Distress...didnt even bring a portable O2 tank in to transport the resident with....So see some EMS workers are also less than efficent.....and the reply i got when i asked about the O2 and why they didnt bring it in was this....."I dont think she needs it.....her O2 sat is up.." yes it was on 10 l she was sating 88 come on.....here is your sign dude.....gezzz

terri

[Dustdevil]

...10 L by nc...

:shock:

Hopefully, somebody got fired over that, right?

[medic001918]

Ok here is a situtaion i was confronted with at work......

I had a 67 yo female resp distress sats were 69% on 10 L by nc.....b/p 210/110 p120 resp 32 t 99

she was cyanotic and sweating....911 was called and the Squad that arrived to transport the resident to the ER ....shows up and guess what....knowing this lady was a full code and in RESP Distress...didnt even bring a portable O2 tank in to transport the resident with....So see some EMS workers are also less than efficent.....and the reply i got when i asked about the O2 and why they didnt bring it in was this....."I dont think she needs it.....her O2 sat is up.." yes it was on 10 l she was sating 88 come on.....here is your sign dude.....gezzz

terri

I'm confused. You said her sats were 69% on 10L and then w/o any intervention her sats were 88 on 10L? And who's giving oxygen at 10LPM via cannula anyway? Something with this call doesn't at add up.

And, the occassional "..." is okay, but it shouldn't replace a standard period at the end of a sentence. Something to think about.

Shane

NREMT-P

[akflightmedic]

I agree Dust. Sounds like the lady was in CHF and the idea was to turn a NC up to 10L, when we all know people in CHF are not breathing through their nose, they are huffing through their mouths. Now I have to ask, who made the call for the EMS crew? DId they relay all pertinent information or just say we have a resident that needs transport? Was the crew 911 or interfacility truck? Not condoning their behavior as I go nowhere without my O2, that was irresponsible but their could be many factors that have led up to this behavior. And yes I agree with you Teri, you said some are inefficient...I say a lot are inefficient but I am just looking at this from the angle of what caused them to act this way. History of BS calls from this home, inadequate training in that service, a whole myriad of things could have caused this. But since you are ranting on it this time and not all the time I am assuming this is a fairly isolated incident in your area. Maybe the crews just had a bad day and forgot and instead of being honest about it they thought the lame excuse of "her sats are up" was better to say. I dont know, but as with everything...there are always many different angles to consider for every situation.

[vs-eh?]

Ok here is a situtaion i was confronted with at work......

I had a 67 yo female resp distress sats were 69% on 10 L by nc.....b/p 210/110 p120 resp 32 t 99

I don't understand how this is different from any other NH "coin". Turning a NASAL CANNULA up to 10L/MIN seems like it would be EXACTLY what most NH's would do...

:roll:

Actually not here though. Most NH "nurses" seem to have very limited standing orders and 99% of the time (from what I have seen) they include basically only for diabetic issues (insulin admin usually) and O2 (very rare). 95% of NH patients that I attend to for SOB, CP, whatever have nothing done. If they do have O2 applied (outside of normal NC use or whatever) it is some retarded SFM at like 3L/min...

[OVeractiveBrain]

I would suggest, when posting in an attempt to justify your credibility and some how 'reverse the coin' of the old addage that nursing homes often provide insufficient care, that you at least attempt to sound intellectual. The series of incomplete sentences and elipses can be quite painful to read, forcing us to deduce that it was EMS personnel that neglected to bring in the Oxygen for a diff breather.

On the other hand, since your story is incoherent as it is (as some one pointed out TEN (10) L/min 02 NC is far above the range of use for a NC which is 1-6L/min, magically improving saturation numbers) perhaps the ems personnel were incorrectly informed of the patient's needs. Telling the dispatcher "shes usualy on oxygen, she has her own tank, which ive turned up" can be relayed to the crew as "Oxygen delivery already established." Granted, it is good practice to come in more prepared than not, but I would not be so quick to jump on EMS as you are, especially when your rant, and seemingly your care, is full of holes.

-Overactive

[becksdad]

Problem is, regardless of what a crew is "informed" of, they still need to do their own assessments. Granted, there's a lot of info missing from the presentation, but anybody who puts (or leaves) a NC on 10lpm needs some "remediation" lets say. Anybody who places a cannula for a sat of 69% needs "remediation". If it was in fact CHF, again, cannula just inappropriate. Removing a patient from O2 who is in respiratory distress is criminal. Not saying all of this is true, but just based on the info provided, that patient was treated very poorly.

[Dustdevil]

NC is inappropriate for anybody who needs over .4 fIO[sub:bcc94917f6]2[/sub:bcc94917f6] delivered.

NC is inappropriate at 6 or more lpm, probably less according to many.

NC is not inappropriate for a mouth breather, unless the patient's nostrils are completely occluded by debris or oedema. The nose and the mouth share the same pharynx, which is where the oxygen goes, regardless of which orofice the patient is using to breathe. Mouth breathers will get nasal oxygen just fine.

[Michael]

a lot of info missing from the presentation

Man, it's funny to read this, plus your talk about NCs and remediation, next to your new avatar, Teddy!

[becksdad]

Ya know, even though we're all aware (I hope) of the basic anatomy of upper airway, I never actually stopped to consider that mouth breathers do receive O2 just fine via NC. But it makes sense the more I think about it.

When I think about a CHFer in distress, I always get a mental image of someone in real distress, and immediately consider NRB or CPAP, depending on the level of distress. My question is this: Do you think, generally, that we overeact/over treat based on parameters drilled into our heads, when more conservative measures may be just as effective and should be tried first?

The more I read, see, and learn, the more often I encounter situations where this just may be the case. But it is still hard to let go of things that we've been using for years. Sometimes, in certain situations, I'm beginning to think I need to unlearn before I can learn more...