Comments on: Oxygen

By: medicscribe

medicscribe — Sun, 28 Mar 2010 13:26:13 +0000

Thanks for all the great comments.

It will be interesting to see how this changes in the future.

Peter C

By: Paramedic Pete

Paramedic Pete — Thu, 25 Mar 2010 22:59:41 +0000

I have to say something about this. Yes giving every patient 15 Litres per minuten 0xygen by NRB is the wrong thing to do and can cause harm. Oxygen is a drug and should be treated as such. But in the same way that COAD patients should have their hypoxia treated initially with higher flow rates and only then have the oxygen titrated down to reflect their chronic condition. I have seen emphysema patients peri-cyanosed on a nasal cannula at 2 litres per minute because someone had bought into the hypoxic drive consensus. I worry that in the zeal to break down established practice we go too far.
I would be intersted in the study which looks at limited supplemental oxygen in acute coronary syndromes and strokes, let alone patients who are short of breath with hypoxia. It seems to me that oxygen given at the ‘goldilocks’ concentration will not cause vasospasm and therefor worsen the condition, but also might help save the pnumbre of tissue which is not yet dead but which is not getting enough vital oxygen. I thing the consensus in the longer term will work out an better medium of care of not tons of oxygen or none at all. I think the rush to dispel the oxygen myth has the potential to confuse providers and cause harm to our patients. Are we sure the science is comprehensive and correct enough to advocate such a change.

By: totwtytr

totwtytr — Wed, 24 Mar 2010 21:41:33 +0000

Oxygen therapy is in a state flux as there is some suggestion that it’s not as benign as we’ve always thought. OTOH, there is a doctor trying to put a study together to test high flow oxygen in Stroke patients. He seems to think it’s beneficial, although other studies show some down side. There are even some studies showing benefit from normoxic ventilation in cardiac arrest.

It will be interesting to see what, if anything the AHA has to say in light of the British Thoracic Society recommendations.

Since our protocol specifies oxygen by appropriate means, I’ve started using less when indicated by the patient’s condition.

As Drudge says, “Developing…”

By: CBEMT

CBEMT — Wed, 24 Mar 2010 01:23:54 +0000

It’s certainly NO reflection on you, but damn if this article getting posted on the JEMS Facebook page didn’t bring out the morons!

By: Dolph

Dolph — Tue, 23 Mar 2010 20:46:03 +0000

Amazing how things are changing! I am glad that research is being done and the bad part is it will take time to revise any protocols. I am curious if any folks have seen changes in the past two to five years?
Logic tells us that we have technology that can aid us in determining if patients are not saturating and require O2 but the true indicator is to LOOK at your patient. Do they look like they are not perfusing well?
Only time will tell if we can say “We used O2 on everyone years ago!”