O2- supervisor's POV

[WuLabsWuTecH]

if the county protocol says under 93 ==> give O2, then I can't really fault the super for it. It may be stupid, but you still gotta follow your protocols!

As for oxygen harming a patient, yes, it can, but you're not going to knock out someone's hypoxic drive/give someone oxygen poisoning/harm someone with oxygen in the time that you have a patient. And if you make the argument (but we're really, really far away from a hospital) then you should quit having your partner take trips through the Sahara Desert and the Antarctic while you are loaded

 

[Chupathangy]

Martor, I almost started laughing uncontrollably when I read this post because I work for that company and I remember VERY well when I got that email. That caused a lot of unrest among the EMTs and ironically one EMT did get in quite a bit of trouble over it at the ED. And no, our Protocols do not state that we must place every low sating pt on high flow. Protocol says "O2 and/or ventilate prn" Sp02 monitoring is fairly new to San Diego EMTs and I wouldnt be surprised if they eventually remove it due to occurrences like this.

And when i say i worked there, i mean, ummm... a friend worked there?

 

[Clipper1]

Anybody care to look up where 92% might place some patients on the oxyhemoglobin dissociation curve for PaO2? Not everyone has the same PaO2 for 92%. If the patient is sick, chances are their PaO2 will be lower at 92% due to the factors shifting the curve. If the person is also a smoker with carboxyhemoglobin or taking nitrates with MetHb on board, the PaO2 could be extremely low to where the patient is now euphoric from hypoxia regardless of that number on your pulse oximeter. An EMT may not have the education to understand all the circumstances affecting SpO2, SaO2 and PaO2.

Sometimes with lack of education, training and diagnostic equipment it is better to error on the side of caution and not waste brain cells, shut down perfusion to organs or enhance hypoxic vasoconstriction especially for short transports. For this reason protocols are written with this in mind. There are just too many disease possibilities such as pulmonary hypertension to discuss in a 110 hour course. Even hospitals may keep a patient on a slightly higher FiO2 until a BP MAP is supported or the sepsis protocol is initiated with improvement.

 

[martor]

And when i say i worked there, i mean, ummm... a friend worked there?

Yeah, same here. A friend of a friends told me about.

 

[JPINFV]

if the county protocol says under 93 ==> give O2, then I can't really fault the super for it. It may be stupid, but you still gotta follow your protocols!

As for oxygen harming a patient, yes, it can, but you're not going to knock out someone's hypoxic drive/give someone oxygen poisoning/harm someone with oxygen in the time that you have a patient. And if you make the argument (but we're really, really far away from a hospital) then you should quit having your partner take trips through the Sahara Desert and the Antarctic while you are loaded

91/92 is when you should be starting supplemental oxygen when titrating to SpO2 (assuming no other indications... i.e. respiratory effort, normally on supplemental, etc). I don't disagree with starting a patient at 92 on oxygen... I disagree with starting a patient on a NRB at 92 baring other issues.