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Nasal Cannula for Cardiac Symptoms?
I was on a call the other day, 50s male with chest pain, cardiac history, pain 8/10, etc. Pulse about 80. NYS BLS protocol states that high flow oxygen should be given via non-rebreather mask. This has been the protocol for the past 20 years at least, and is also considered routine medical care for all levels in our area.
ALS arrives on scene while I prepare the NRB. The ALS tech says "No, put him on 4 lpm with a cannula." I considered that a moment, then said "Nope, I'm giving him 15 per protocol."
Two or three minutes later, the patient reported vast relief from pain with the NRB. Having transferred care over to another crew, I watched as the ALS tech removed the NRB so as to get a room air sat level.
Apparently, there is some belief that indicates that too much oxygen can constrict the cardiac vessels and complicate the situation. However, a "belief" is overruled by protocol, in my book.
Any thoughts or data on this?
ALS arrives on scene while I prepare the NRB. The ALS tech says "No, put him on 4 lpm with a cannula." I considered that a moment, then said "Nope, I'm giving him 15 per protocol."
Two or three minutes later, the patient reported vast relief from pain with the NRB. Having transferred care over to another crew, I watched as the ALS tech removed the NRB so as to get a room air sat level.
Apparently, there is some belief that indicates that too much oxygen can constrict the cardiac vessels and complicate the situation. However, a "belief" is overruled by protocol, in my book.
Any thoughts or data on this?
Replies to This Discussion
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Permalink Reply by Bonnie on
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Thanks for the link, Ben. Some great information in there. I reiterate my earlier comment that Oxygen is a drug and more is not necessarily the right answer.
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Permalink Reply by Ben Waller on
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Paracelsus (1493-1541) once famously said (I paraphrase here)
"Everything is a poison. There is nothing that is not a poison. Dose, not the substance, makes the poison."
According to old Paracelsus, oxygen is a poison if you give someone enough of it.
I compare that to our physiological need for water. We can't live without it. However, people have died from water poisoning when they drink too much of it.
Here's an example of a fatality that resulted from water poisoning: http://www.msnbc.msn.com/id/16687211/
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Permalink Reply by Reap on
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Ok, the whole COPD thing bothers me because it makes us look uneducated. Obviously if a person is having SOB, their home 2 lpm via NC on a concentrator, IS NOT WORKING!!!! Secondly, the ride to the hospital is short enough to where advanced medical care (doctors and nurses) can look after a pt's sats after that.
Secondly, just remember that EMT's are alotted 15lpm of O2 as a standing order. RN's can only give up to 2lpm of O2 without needing a Dr's order. This 15 lpm is basically covering our "what if" scenario until ALS arrives.
3rd, ALS arrives, its their patient. They assume total care over the patient. No argument. Oxygen is a drug. I'm not going to tell them how much nitro to give because my BLS protocol is different.
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Permalink Reply by Kenneth Holley on
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We don't even carry NC onour trucks. It's NRB @ 15lpm or not.
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So much for 6 lpm via N/C if 15 and mask is intolerable for the patient per protocol????
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Permalink Reply by David on
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ALS was not wrong and we where not their so we dont have a complete ideal of what was going on. The pt did not have O2 withheld, and the ALS protocal may be different then BLS ones. The medic can titraed to effect.
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Permalink Reply by Julie on
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Yeah. I agree. We treat the pt, not the equipment telling us things. If the pt is sitting upright having a conversation, talking, breathing adequately, and overall okay, then give em a NC. Without a doubt, follow your protocols. Obviously 02 never hurts anyone but to me, people get anxious, sometimes, when you put a NRB. The NC isnt as bad. IDK. Great topic for thought though!
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Permalink Reply by Dustin J. Millis on
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Wow, lots of good discussion on this one. Whenever I have a pt. complaining of any difficulty breathing, I always start them off with 15 lpm via NRB. If they dont like it, too bad, I really try to convince them to leave it on. If they absolutly cannot stand it, I offer them the nc or just offer to hold the mask close to their face for blow by. On the other hand, if a medic gets on scene and tells me to do something, apart from jumping off a bridge, you can bet I am going to do it. I figure its their years of solid education against my 6 months,
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Permalink Reply by Cody W. Nelson on
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I have been in discussion with several EC and internal med physicians about this issue. I read them the beginning statement of this topic. This usually doesn't happen, so it's why I am adding this. Everyone of the doc's that I spoke with all have the same opinion. They all stated that it WOULD be beneficial to the patient if the patient were put on 10 Lpm via NRB. There are studies that show high levels of oxygen sustained for several days have had bad outcomes for patients. Most of the docs also agreed that a patient would have to be on O2 10 Lpm for more than 3 to 4 days before they would start to show any ill effects. With that being said, I believe that Joe did the right thing, but, if the transporting paramedic wants to take the patient off of O2 via NRB and place them on a cannula, that's okay too. We "practice" medicine my friends, which means that it is not an exact science. What is good for one patient may kill the next one. Good discussion. I think this really got some wheels to turn.
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Permalink Reply by Timothy D. Stone Jr on
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id go with that any time...chest pain possable heart attack 15 lpm via NRB
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"If they don't like it, too bad."
For starters, the patient has the legal right to refuse any treatment he or she wishes. If you force treatement on a conscious patient who is refusing it, it won't take much of a prosecuting attorney to convict you of assault and battery. At the very least, your career would be in jeopardy.
After all, criminal law supercedes your protocols.
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