Contradictions on Giving Oxygen

Hey all this is my First post so bear with me on this!

I'm in my Anatomy and Phisology class for my Paramedic this fall. We have a test coming up on tuesday, and our instructor is an experienced paramedic himself. He gave us a 2 part 5pt bonus question. One deals with HAZMAT and I have that done. The other deals with the topic of the post: When is Oxygen Therapy contradicted? I need at least 2 situations. I think that major trauma to the lung (like a Pnuemothorax) would be one of them , but I'm not sure. Any help would be greatly appreciated.
Thanks Guys!
John
EMTB Ohio

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Permalink Reply by Johnathan Turner on July 16, 2008 at 5:02am

Okay, the answer was (drum roll please)

Both Paraquat and Diquat Poisioning and High flow oxygen in Premature Neonates leading to ROP.
Also Neonate with Ductal Dependant Cardiac Lesion and Hypoplastic Left Heart Syndrome.

Some folks had a hard time finding this. Some even went to respirtatory Therapists and came back with nothing. So there you have it. Long walk off a short pier.

Answers from my classmates varied from the obvious (the cardiac problems) to the fantastic (on Fire, death).

The path he was leading us down was to not just blindly put the pts on oxygen, but to actually examine and treat the patient for what is wrong with them. Like most of us said, we have never heard of with holding Oxygen. The idea of this bonus, in my humble opinion, was to demonstrate that every thing we do to the patient has a downside as well as an upside. This class is used as a lead in for the medic, so perhaps the intention of this little exercise was to demonstrate that we need to think out more carfully what we do to our patients as we treat them. As stated earlier; Above all, Do No Harm.

Stay safe folks and get home.
-John

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Permalink Reply by Oldman on July 16, 2008 at 11:28am

I don't impress too easily, but that ability would be impressive!

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Permalink Reply by Ben Waller on July 16, 2008 at 10:40pm

I need to sign up for those X-ray eyes myself. Rather than using them for the one (or zero) preemie per career with the DDCLaHLHS that John described, I think I'd use them to discover fire in void spaces, to determine liquid levels in hazardous materials containers, and to vizualize incipient stress cracks in the concrete at the next structure collapse to which I respond. Oh, and I'd put all the weld X-ray techs out of business at a few nuclear plants.

If I had that capability, I wouldn't waste my time on being a mere paramedic instructor, though. I'd be leaping tall buildings at a single bound, catching speeding bullets in my teeth, and wearing tights and a cape. Belive me, NONE of you want to see me in tights! I'd just have to tell you "It wasn't a thong when I put it on."

Ben

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Permalink Reply by Johnathan Turner on July 16, 2008 at 10:55pm

Pretty much I guess that would be involved in pt History. Honestly, he was just asking for O2 Contradictions, and I think he took whatever we threw at him. He kinda begrudgingly took the cardiac answers. His main warning was to full examine the patient. Ask questions and try and get the big picture. If the patient don't need it, then don't give it. While I disagree with this thought, I can see the logic in his statement. Figure out what is really going on with the patient to better treat them.

Treat the Cause, not the symptoms.

But enough pontificating from me for one day.

Stay safe and Get home
John

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Permalink Reply by Ben Waller on July 16, 2008 at 11:07pm

John,

Unfortunately, you're going to spend a lot of your career treating the symptoms, not the cause. A lot of the time, treating symptoms is the best you can do.

A lot of treatments for the cause are ineffective, unfortunately. For example, even EMS systems with relatively astronomical CPR save rates like Seattle and Raleigh don't save even 50% of their cardiac arrest patients, despite huge advances in how they treat those patients. Another example is that it's pretty hard to treat the cause of a multiple-system trauma after the head-on occurs.

Your instructor did make a good point, though. A lot of ALS interventions - and even some BLS ones - that have been taught as alway helpful or at least not harmful turn out to be harmful in some situations. Oxygen and a number of common EMS drugs are good examples.

Remember another basic rule of medicine..."When you hear hoofbeats, look for horses, not zebras." That's a good rule of thumb, but just when you look for the umpteenth horse, a zebra will flatten you into the dust and leave hoofprints on you from head to toe.
When that happens, treat symptoms and call Medical Control for help.

Good luck in your career and keep up the inquisitive mentality.

Ben

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Permalink Reply by Ben Waller on July 16, 2008 at 11:08pm

If there are "men" in my tights, I have bigger problems than just choosing a high-risk profession. Keep it up and I just might post a retina-damaging photo. :-)))))