Oxygen rate for Chest Pain?

[Richard B the EMT]

I mentioned the Watkins case as example of how our field continues to evolve. Today, I start treating chest pain, cardiac or not, with the NRB @ 15 lpm. Who is to say, either direction, next week, I get told to deliver a different amount, or next month, use a different delivery system?

You see my mantra re local protocols. I stand by them, as, admittedly, I treat patients. If research is being done, I will pass along my results, by either the current standards, or using whatever standards I was told to use in the test program. I, myself, am no researcher, but will follow whatever my higher medical authorities tell me to do, as I am confident all of you either do, or should do.

[ccmedoc]

I cant believe that this is still a discussion...Too much oxygen to the wrong person, ESPECIALLY cardiac patients, can be a very bad thing. I believe that local protocols need to be followed, but protocols are guidelines and most generally not to be held as a recipe treatment. At the time you begin delivering a drug or a treatment, YOU become the expert. By accepting the license to practice, ignorance ceases to be a defense..Protocols can be changed, and should be changed in lou of new compelling research to do so. delivering treatment because its the way we've always done it is the wrong reason..EMS has traditionally used empirical treatment strategies and these strategies must be and will be changed to meet new standards of care. these are my previous posts and I stand by them. It sounds like more than a few areas in the states could use additional research in their protocols and change them accordingly. Why is it so hard to believe that something as seemingly simple as oxygen administration could be so devastating?? The biggest problem I've seen in these posts in the unwillingness of some to take the initiative and do the necessary research and educate others in these matters.

Posted: Thu Jun 14, 2007 6:15 pm Post subject:

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Well, decreased cardiac output would equal decreased tissue perfusion ie. brain, kidneys, heart, etc. A sat of 92% is not that bad unless there is accompanying respiratory problems, in which case, it possibly may be difficult to acheive this. Another factor is if the pt has a Hx of COPD and is chronically retaining CO2. There are many factors that affect oxygen saturation and oxygen delivery that are beyond the scope of this reply. Generally, classic angina and variant angina respond very well to around 40% FiO2, which would be nasal cannula at around 4lpm. With vasospastic angina, high FiO2 could exacerbate the problem and possibly introduce more problems..It is a long drawn out issue that could be discussed for hours. I believe you will find that most will say that high flow O2 is overkill and possibly harmful..

Posted: Thu Jun 14, 2007 6:24 pm Post subject:

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I see that there are both BLS and ALS (presumably) protocols present. As a Basic, I would say to never with-hold oxygen, but as a Medic you should have the freedom to decide whether your patient is in need of the high flow or not. To say that any person with a sat below 95% or so gets high flow oxygen is ludicrous and these decisions should be evaluated. The seemingly harmless overzealous administration of oxygen could be devastating in the wrong patient..be careful and be safe..

-steve

[qoute]

Remember, ignorance is no defense in any case..

Read the study a few posts back..one of many that show the effects of oxygen admin..

Flame away!!!!---Steve

[Richard B the EMT]

Just as a point of identification, I am using my authorized BLS protocols, as a BLS provider in a multi-level agency (CFR-D firefighters, BLS by EMT-Bs, and ALS by Paramedics).

[AZCEP]

The problem that I have with what you are saying, Richard, is the fact that your protocol is being followed without questioning the utility of it.

If you are allowed to administer 15 liters per minute of oxygen using a non-rebreather mask, why are you not allowed to use a lesser device? Is it simply due to "this is how we've always done it"? Could it be that no one has thought to question this?

I fully understand that you can only do what you are allowed, but this is not a good way to present an EMT's ability.

[Richard B the EMT]

I have also seen a few of my compatriots fired for "freelancing" outside the NYS DoH protocols, or the department's.

[ccmedoc]

No one here has condoned "freelancing". Only educating yourself and others on the changing views of medicine and standards of care, and questioning standards that appear to be outdated or of questionable safety..Maybe a clarification of your protocols should be in order as I doubt if you are able to deliver high flow, you would be denied starting with low flow oxygen. Especially with compelling evidence to the fact that high flow oxygen can and does have negetive effects on cardiac and systemic circulation, especially at critical times such as variant angina and vasospastic angina. How would you explain taking a patient with an episode of apparent angina and progressing this to infarct by the seemingly benign administration of oxygen. This would be inexcusable with the amount of research to becoming available describing the negative effects of empirical administration of high flow oxygen for chest pain without evidence of respiratory compromise. I doubt a firing would take place by asking for a clarification of the protocols you are under in the context of oxygen intox. or vasospasm/vasoconstriction related to overzealous administration.. You owe it to your patients and your practice to investigate this further. Your physicians responsible for the protocol development couldn't possibly hold it against you for this presentation..

[Dustdevil]

No one here has condoned "freelancing".

Perhaps you missed this post...

Go big or go home. That's why I tube all my chest pain patients. I was taught that the only definitive airway is an ETT and obviously without A you can't go on to B or C so I first secure A.

[ccmedoc]

No it was not missed, just discounted as babble..perhaps I should have said no one here qualified has condoned freelancing :wink: :roll:

[tniuqs]

I mentioned the Watkins case as example of how our field continues to evolve. Today, I start treating chest pain, cardiac or not, with the NRB @ 15 lpm. Who is to say, either direction, next week, I get told to deliver a different amount, or next month, use a different delivery system?

You see my mantra re local protocols. I stand by them, as, admittedly, I treat patients. If research is being done, I will pass along my results, by either the current standards, or using whatever standards I was told to use in the test program. I, myself, am no researcher, but will follow whatever my higher medical authorities tell me to do, as I am confident all of you either do, or should do.

Richard: Ok, I am not trying to start a war, really, but this protocol following is blind following of the leader like in playschool and is not freelancing renegadism. Well unless starting with 15 lpm is set in farking stone tablet somewhere: I think that the point (although controversial) should be intelligently presented by those that are providing initial front line health care, and these new concepts (research based) and treatment modalities should be forwarded to those that DO have the authority to change the "paint by numbers' picture book, perhaps a professional responsibility in point of fact?

This mentality is very indicative of an overall problem for your advancement in the USA and the future of the EMS system there, in my humble perspective (and I am not pointing fingers) just south of the poorly defended border.

The "Tecky vs. the Practioner Concept" this has been quite clearly demonstrated with numerous posts on this topic. So just follow the pre made cook book and the rules of engagement out of fear of litigation... simply a sad commentary overall. Hey do you remember when a witnessed arrest got 1 amp out of the blue box...and 2 amps for unwitnessed arrest...we were giving the "coup de grace" (excuse my french svp)! Perhaps a good thing the researchers looked into this notion. as for research and inclusion of studies in the field dare I say we should not do our part in the new equation?

ccmedoc quote:

You owe it to your patients and your practice to investigate this further.

Nicely stated but, + 5 on the dust devil scale, but in addition (if you may be so kind to add) : To your profession (maybe even include this in your code of ethics) therefore put the onus on the practioner to advance the profession not others.

ps: Have you ever noticed "My Mantra" I am not under the delusional belief that I am a "Life Saver" as the Great Spirit has not visited me in my sleep and declared me on a Mission, well just yet..... although, I do were my sunglasses at night and I did watch the Blues Brothers movie! This idea too, of self image is also a detriment to further development of the profession in my freelancing perspective.

In closing :

I believe I know what the cc stands for in this signature and so does dust....bit of baiting going on here? But then again Dust is very old and So stuck in his ways...sad but very true, come on dust open your eyes to progress.... :twisted:

[Dustdevil]

Ok, I am not trying to start a war, really, but this protocol following is blind following of the leader like in playschool and is not freelancing redigadism.

Straight up, dude.... admit it. You just made that word up, didn't you!

I believe I know what the cc stands for in this signature and so does dust....bit of baiting going on here? But then again Dust is very old and So stuck in his ways...sad but very true, come on dust open your eyes to progress.... :twisted:

Hey, when something works for me, I stick with it!

And I don't know what you're talking about with this "old" stuff. I'm still in my second adolescence! :wink: