fiznat Posted January 10, 2007 Share Posted January 10, 2007 Close, but... Yeah, I know... I meant mostly to distinguish between aerobic and anaerobic respiration in my post, but you are correct in that the Kreb's cycle is definitely not the only step in production of ATP in the presence of oxygen. Good clarification. Link to comment Share on other sites More sharing options...
VentMedic Posted January 10, 2007 Share Posted January 10, 2007 Back at ya OzMedic. Excellent points in your post. I too agree there is a place for pulse oximetry. However, all I need is the pt to say "I am having trouble breathing." The pulse ox is nice but may not present the whole picture. I will start some type of treatment; O2, nebs, MDIs, whatever based on what the pt is saying, how they look and sound before messing around with a "sat". I will also make plans to intubate long before I see the SpO2 drops by their presentation. Also, SpO2 of 78% doesn't always mean a tube. If they are still talking in decent sentences...I'll try my best to keep them from the tube. Of course, I don't want the heart or head to take a hit either...the whole pt. People also over analyze the COPD thing. CO2 retainers make up a very small portion of that population. A little wager among the RTs and Medics in the ER is betting on the blood gas CO2. Rarely is their normal CO2 elevated enough to be classified as a retainer. For the COPD pt in exacerbation we use Winter's Formula; (1.5 x HCO3) + 8 to find the normal CO2 for the pt. This helps if we put them on a vent. We are careful not to get below their HCO3 compensated normal on the CO2. If we do take them down too low, the body dumps the HCO3 and we are stuck with a pt on a vent that should have been an easy wean. You've heard of the pt "failing" extubation? Many times their pre-extubation ABG is 7.40/40/80/22 instead of 7.35/60/60/35. The ET tube is pulled and the lungs put the CO2 back to 60 and the HCO3 is too low to compensate, thus pH 7.2. Also, I have actually had CO2 retainers tell me that they don't believe in the hypoxic drive dangers. Why? If it was that easy to knock out their drive; perfect for suicide or insurance collection by a loved one. In the hospital, the COPDer's do their own oxygen therapy when nobody is around. I scold them just because I have to chart something decent to get them discharged. 6L instead of 2L doesn't cut. But, if that's what they really need...so be it. We rework the home care plan. You also made a point about US medic programs. I agree there also. There are a lot of "diploma mills" still existing in the profession. It is still taught with a certificate design. The degree is an option but under utilized. For the medics to gain professional status and pay, the majority has to get on board and raise their entry level standards for EMT-P. College level A&P should be a requirement at the very least. I've seen State and National organizations come and go. I got my A.S. degree in EMS way back in 1979. We were encouraged to because that was the future so it be told. Luckily it prepared me for further education when my home State was slow to recognize the profession. Respiratory Therapy started getting recognized in the 80s. Now, the entry level is A.S. with B.S. preferred in many areas. The diploma mills had to go to gain credibility and pay. North Carolina licensure clearly spells out what an RRT can do outside the hospital. Of course, not to replace EMT-Ps (not enough RTs), but to make their education and experience known. http://www.ncrcb.org/Declaratory%20Ruling%...d%2010-7-04.pdf Also, back to SpO2, a good medical emergency(and deadly) situation has presented itself in Key West, Florida at a hotel. CO poisoning. All the symptoms of CO poisoning presented by the pts...but Key West? No furnaces. The boiler was later faulted. http://www.keynoter.com/articles/2007/01/05/news/news09.txt Link to comment Share on other sites More sharing options...
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