Sexual Assault - Scenario Posed in my class, What would you do?

[papyrusman2000]

just a thought: Given the circumstances (R: 28, and the fact that she was just raped), wouldn't you try calming her down with a bit more oxygen than a Nasal Cannula could offer?

15 lpm mask?

yes... no... maybe so?

 

[Bosco578]

just a thought: Given the circumstances (R: 28, and the fact that she was just raped), wouldn't you try calming her down with a bit more oxygen than a Nasal Cannula could offer?

15 lpm mask?

yes... no... maybe so?

No. What is a NC or NRB going to do for her? Why does she need oxygen to begin with? She is upset, perhaps hyperventilating due to the stress and anxiety.

 

[mikie]

No. What is a NC or NRB going to do for her? Why does she need oxygen to begin with? She is upset, perhaps hyperventilating due to the stress and anxiety.

wouldn't hurt...perhaps it might calm her down. as we discussed in a different thread about its therapeutic benefits (as some called it 'placebo' affect)

 

[Bosco578]

wouldn't hurt...perhaps it might calm her down. as we discussed in a different thread about its therapeutic benefits (as some called it 'placebo' affect)

So your going to slap on a NRB because hey, why not. Nice.

 

[papyrusman2000]

IDK... going by the books I guess thats what you would do... plus like I said she just got friggin raped... I'd want some O2 if I was a girl that just got raped...

but since I'm just a guy I'd probably be good with a cigarette.

 

[papyrusman2000]

You know what... come to think of it... if there isn't a risk for hypoxia, then WHY THE F##K NOT?!

I think it would be worth the extra few words I'd have to right out on the run report to calm the pt nerves and help her out in really the only way possible in this case. Shes not wanting to talk much, so let her just suck on some O2 and relax on the way to the hospital.

Besides if you look at it from the "technical" stand point, I'm pretty sure your supposed to deliver O2 to a patient with an R rate of 28... generally not always 15 via mask, but like I said in this case: WHY THE F##K NOT?!

Hey screw me, right? I'm just an EMT-B.

 

[Ridryder911]

Treat the patient appropriately. Slapping oxygen onto a anxious, nearly hyperventilating patient will probably have no physical benefits. As well, why administer the wrong treatment?

Really, think what happened.... what just occurred? Does this patient really need improved oxygenation? Or is it since you feel you cannot provide anything else, you slap on the oxygen to make yourself feel better that you did something.

Maybe the best treatment is to be sure that the most appropriate health care team has been notified and to make sure no life threatening injuries occur. Making sure the arrangements has been made for the continuation of care and then removing yourself from the scene.

Sometimes, we are not the best providers for certain conditions and definitely oxygen is NOT the magic pill to cure all problems. Remember, oxygen is a MEDICINE/DRUG! Would you administer any medications without the need to?

R/r 911

 

[BossyCow]

I'm not likely to give oxygen to this patient. I've seen too many pts hyperventilating into a NRB because some well meaning soul thought it 'might help'. An anxious pt who has just been through a trauma needs your attention, your calm, your professionalism, your discretion but does not need O2. Putting a mask on the pt may help you distance yourself from their pain or their situation but will do little to address the emotional impact of the event.

If someone is bleeding, apply pressure to the bleed. If someone is hypoglycemic, give them sugar. If someone is emotionally upset give them oxygen???? The treatment should have some benefit to the patient.

 

[Bosco578]

Treat the patient appropriately. Slapping oxygen onto a anxious, nearly hyperventilating patient will probably have no physical benefits. As well, why administer the wrong treatment?

Really, think what happened.... what just occurred? Does this patient really need improved oxygenation? Or is it since you feel you cannot provide anything else, you slap on the oxygen to make yourself feel better that you did something.

Maybe the best treatment is to be sure that the most appropriate health care team has been notified and to make sure no life threatening injuries occur. Making sure the arrangements has been made for the continuation of care and then removing yourself from the scene.

Sometimes, we are not the best providers for certain conditions and definitely oxygen is NOT the magic pill to cure all problems. Remember, oxygen is a MEDICINE/DRUG! Would you administer any medications without the need to?

R/r 911

Thank you Rid. Well said.

 

[reaper]

You know what... come to think of it... if there isn't a risk for hypoxia, then WHY THE F##K NOT?!

I think it would be worth the extra few words I'd have to right out on the run report to calm the pt nerves and help her out in really the only way possible in this case. Shes not wanting to talk much, so let her just suck on some O2 and relax on the way to the hospital.

Besides if you look at it from the "technical" stand point, I'm pretty sure your supposed to deliver O2 to a patient with an R rate of 28... generally not always 15 via mask, but like I said in this case: WHY THE F##K NOT?!

Hey screw me, right? I'm just an EMT-B.

I think you answered your own question in that last sentence!

 

[papyrusman2000]

ok ok hate on the rook'. thats all fair and wonderful. whatever.

I guess I didn't state my question/point (if there is such a thing) in a manner that only the most INTELLIGENT and PROFESSIONAL EMS provider could answer.

1. Of COURSE you would handle the call via protocol. Call it in to the receiving hospital, prepare for the hand-off of pt, etc etc. PROTOCOL PROTOCOL!

2. Since this is just a scenario, many "what ifs" and so-ons could be thrown in. duh.

3. How HARMFUL would it be to administer O2 to a pt in this condition? We all tried O2 on ourselves. We ALL know it (in the smallest way) helps calm you down. AFTER the necessary assmts. and actions taken to ensure competent and efficient care, safety, and comfort to this pt, would it truly be an ignorant and (at the very least) morally unnecessary action to follow through with? SHE JUST GOT RAPED. O2 MAY be a nice thing.
"Ms. So-and-so, would you like us to administer supplemental oxygen to you to help you calm down/relax/whatever?" I can't tell you what I would really say, but I'm good at improv, even in delicate situations.

Before you respond after reading this, just know that this is -I guess- my way of learning. If I have a different understanding of something, I will present that aspect until somebody convinces me otherwise.

I AM IN NO WAY AT ALL TRYING TO UNDERMINE OR QUESTION YOUR EXPERIENCE, NOR AM I TRYING TO BE A SMARTA55. Im a n00b at this whole thing, so please help me become a pro... preferably without being a d1ck...

Thank you all for being active members on this website. I have learned so much from all of you in the last few days it's phenomenal .

on another note....

 

[mikie]

So your going to slap on a NRB because hey, why not. Nice.

I didn't say I had no reason to "slap it on her." If I find it doesn't help her anxiety (as it affects her breathing), I can cease it at anytime with no harm done. This is of course being done while attempting other means to comfort the patient and provide care.

Why not have her breathe into a paper bag? (not seriously, although I am interested into its actual 'use')

 

[reaper]

First, You need to learn to write your posts as questions. To me, (and many others) you came across as a smart ars new EMT that learned all there is to know, in EMT class. I know that sounds harsh, but that is how your posts sound.

You can learn a lot from the people here, that have years and decades of experience. Most of us were doing EMS before you were born. We have seen these situations over and over again.

We are trying to tell you that a NRB at 15 lpm is not a justified treatment for this pt. You have a female pt that was forcibly raped. She is scared and anxious. Placing a confining mask over her face is not going to help her. It will make her anxiety worse.

As you learned in class( I hope), hyperventilation leads to inadequate gas exchange. The pt is unable to blow off Co2 and is retaining O2. Placing her on high flow O2 is not going to help her blow off Co2. Yes, some people will calm down some, with O2. But, I have seen them pass out from the same treatment. This is not what the pt needs at this time.

The best thing you can do for her is let her calm down. Talk to her in a calming voice. Do not ask questions of the event. Just use a little empathy. This can be one of the hardest parts of the job, but it is a part of it. You learn how to deal with a pt like this over time and from advice from people that have been there all ready. Go to your larger ED and talk with the sexual assault RN, they can give you advice on how to best deal with the Pt's.

So, don't be cocky, don't be a smart ars and ask all the questions you want. These people are on this forum to offer advice to the noobs. Hopefully to help you become a great professional.

 

[mikie]

I wish I knew it all. I know I am new, well kinda. I didn't mean to make my threads sound as if "this is the only option." And by no means am I trying to be a smart 'ars,' it's just my take on it. I guess (being late at night, at least for me at the moment and tired of studying for A & P), I made my post sound as if it is the end-all-be-all as opposed to a question (probably lack of solid grammar at the moment too, hindering my question-making sentences)

However, where was the question in your post?

My goal for this patient would not be to solve her problems, but to provide treatment and care for what I come across. I want to get her to the hospital and let the rest of the medical community take great care of her and let the PD throw his ars behind bars.

Perhaps she is hyperventilating because she is trying to compensate for lack of O2 (if that made anysense)? That would be my reason for using a NRB (perhaps not even using 15lpm or strapping it on, rather use at her discretion). Maybe step down to a NC. Was there any evidence of physical trauma suggesting O2 (vaginal bleeding? DCAP-BTLS...) be necessary?

And maybe...use nothing at all (airway-wise) except trending vitals and continuing care.

Thankfully this is a SCENARIO and I am grateful to learn what others take on the proper treatment would be.

and on that note...good night!

 

[reaper]

Mikie333,

That was not for you. Your posts always come across as wanting to learn. You are doing great!

 

[VentMedic]

Okay. Another lesson on hyperventilating, hypoventilating, hyperoxygenating and hypo-oxygenating.

Not all hysterical people "hyperventilate". Some actually hypoventilate because the breaths they take are ineffective.

Sidenote: This is why we don't do nebulizer treatments on crying or screaming children.

Thus, oxygenation can also be affected.

Sidenote: I hate doing an ABG on a crying or hysterical patient, be it an adult or child, because the PaO2 always looks bad as does the PaCO2 (which can be low or high).

Hyperventilation and hyperoxygenation can truly only be determined by an ABG.

A patient can also be on a NRBM and have a large A-a gradient for many reasons. Their SpO2 might even be 100% but you don't know where the PaO2 is on the oxyhemoglobin dissociation curve or what is the actual value of the PaO2.

If nothing else it can be distraction in an otherwise uncomfortable situation.

I've even been asked by a physician to give an Albuterol neb to a rape victim n the ED because the vocal cords quivered. Right? No. Did any harm? No. You have to weigh the odds and alternatives for each situation.

It is just that it is understood why you are doing it which could or could not be for a medical benefit. You may not know in the field and you will be with that patient for only a short time.

There are alot of things that can be debated in medicine. We give O2 for migraines. Another teaching hospital might be trying to disprove the effectiveness. We run 95 - 100% FiO2 as part of the sepsis protocol which contradicts ARDSnet if both protocols are in place. We still will do a "nitrogen washout" as treatment for a pneumo. Some think that is crap. The hypoxic drive has been debated for 40+ years. It even has a 3 day international conference dedicated to it. CPAP is now even being debated as to its effectiveness in some literature. Albuterol for hyperkalemia? Albuterol for beta blocker OD? Nebulized lasix? Flolan or Nitric Oxide for pulmonary hypertension? Hypercapnia or Subambient O2 for ductal dependent lesions in babies? Morphine or fentanyl? Dealer's choice.

Rape is not an easy issue and EMTs or Paramedics are not trained well enough for such traumatic emotional events. There are times when you just have to go with whatever you have to offer to get through a bad situation. Yes, O2 is a med but you may have to give it a try just to get this patient through a very uncomfortable ride to the hospital if you think it might have some benefit.

I, myself, have not been raped. However as the female partner, I have been placed in the back with many rape victims through the years, both male and female. Each patient has different needs and different ways of expressing them. We still must not lose sight that the body has just endured a cascade of emotions, HR increases and stress. We don't know how each "body" will respond and each may respond differently. Trying to put all patients into the same cookbook recipe under Rape does the patient more injustice.

 

[reaper]

Very well written Vent.

All Pt's are different, that is why you learn over time how to deal with different situations. That is why I advised him to talk with a sexual assault RN. They go through the training to be able to best deal with the Pt's. They can be very helpful and a wealth of information on the subject.

 

[VentMedic]

As you learned in class( I hope), hyperventilation leads to inadequate gas exchange. The pt is unable to blow off Co2 and is retaining O2. Placing her on high flow O2 is not going to help her blow off Co2. Yes, some people will calm down some, with O2. But, I have seen them pass out from the same treatment. This is not what the pt needs at this time.

Gotta clean this up a little reaper.

Hyperventilation is blowing off CO2 and can be determined by an ABG.

If the patient is feeling "air hungry" or "can't catch their breath" the O2 may help saturate remaining Hb or psychologically give them some security. Once they calm, the O2 can be removed. It the patients get more hysterical with the mask, it can be removed. If they pass out, it could be from other reasons also since the body is responding to a wide range of physical and psychological reactions. If they pass out, you're probably going to give O2.

 

[reaper]

No problem, That's why you are the RRT!!

 

[papyrusman2000]

First, You need to learn to write your posts as questions. To me, (and many others) you came across as a smart ars new EMT that learned all there is to know, in EMT class. I know that sounds harsh, but that is how your posts sound.

You can learn a lot from the people here, that have years and decades of experience. Most of us were doing EMS before you were born. We have seen these situations over and over again.

We are trying to tell you that a NRB at 15 lpm is not a justified treatment for this pt. You have a female pt that was forcibly raped. She is scared and anxious. Placing a confining mask over her face is not going to help her. It will make her anxiety worse.

As you learned in class( I hope), hyperventilation leads to inadequate gas exchange. The pt is unable to blow off Co2 and is retaining O2. Placing her on high flow O2 is not going to help her blow off Co2. Yes, some people will calm down some, with O2. But, I have seen them pass out from the same treatment. This is not what the pt needs at this time.

The best thing you can do for her is let her calm down. Talk to her in a calming voice. Do not ask questions of the event. Just use a little empathy. This can be one of the hardest parts of the job, but it is a part of it. You learn how to deal with a pt like this over time and from advice from people that have been there all ready. Go to your larger ED and talk with the sexual assault RN, they can give you advice on how to best deal with the Pt's.

So, don't be cocky, don't be a smart ars and ask all the questions you want. These people are on this forum to offer advice to the noobs. Hopefully to help you become a great professional.

ok... so i guess these sentences:

"I AM IN NO WAY AT ALL TRYING TO UNDERMINE OR QUESTION YOUR EXPERIENCE, NOR AM I TRYING TO BE A SMARTA55. Im a n00b at this whole thing, so please help me become a pro... preferably without being a d1ck...

Thank you all for being active members on this website. I have learned so much from all of you in the last few days it's phenomenal."

weren't really needed to be typed by me, since you were so eager to jump on my "smart ars" and criticize me on being such a "smart ars."

I'm well aware of how I sounded, HENCE the last few sentences I typed in my post.

whatever man. no matter how dumb I sound, please don't cut me down and try to make up for it by using the same dumbass smiley face I used to try and make it look innocent. thanks.