Category Archives: Oxygen Therapy

Question: For teaching purposes. While assessing a patient, how important is it to determine any and all treatments or interventions provided to the patient by allied agencies, bystanders, self-administration or other medical professionals prior to the arrival of the Paramedics? How important is it to determine an accurate time line of those treatments or interventions? Is oxygen a treatment and/or intervention?

Question: Is PEEP being considered for inclusion into the paramedic scope of practice? I recently had a patient who was in CHF to the point of unconsciousness whom we would have absolutely given CPAP had he been conscious. Although PEEP isn't exactly the same as CPAP, would it not have potentially provided some benefit?

Question: I would like to know the actual medical directive and/or guidelines regarding PCP's transporting trach patients with no nurse, doctor or RT escort.

Additionally, what the medical directive is if staff is sending the patient to the ER without their vent, therefore, the paramedic is required to bag the patient via BVM for the duration of transport and until there is transfer of care at the ER?

Is this in the BLS scope of practice?

Question: If respirations are at or above 28, historically paramedics are taught to assist via BVM. What is the rationale with pulmonary edema to apply NRB with tachypnea instead of assisting with a BVM until CPAP and or nitro is prepared?

Question: With respect to use of an OPA, I have had discussions with coworkers who always will insert one with an unconscious patient. Is this proper? My argument is, even the MOH literature seems to state that 'less invasive' airway management such as positioning, suctioning and constant monitoring of the airway is acceptable. Some common situations of this would be a post-itcal or alcohol intoxication persons. Thanks.

Question: I like to give O2 to patients for pain (when not contraindicated) even if their stats are good. I have done this for years and have found that it seems to help. A fellow paramedic felt that this was a very useless application. I disagreed. I have looked for scientific evidence for this working and have found little on it. I was wondering if you would comment.

Question: What are your thoughts on oxygen therapy in myocardial ischemia from a medical evidence standpoint? Even though high flow o2 is regularly administered to PTs with chest pain as per the oxygen therapy and chest pain standards in the BLS standards, there is an increasing body of evidence suggesting that in uncomplicated MI O2 is of no benefit and may cause more harm than good due to ROS and ischemia-reperfusion injury.

The recent ACLS guidelines state to only administer O2 in acute coronary syndromes if the spo2 is < 94% or the PT is in respiratory distress or obviously hypoxic and there are several recent papers and clinical guidelines that suggest a similar course of action in uncomplicated MI. Basically, the evidence is suggesting that titration to spo2 is favorable over high flow o2 due to the risk of oxidative stress injury.

Any thoughts? Obviously you still follow the protocols, but I'm just interested to see if there is any medical opinion on this. Could the standards/guidelines eventually change to reflect the newer evidence?

Question: With these new medical directives, I was under the impression that we as medics are able to use our judgment and discretion on calls. It is mine and many of my colleagues opinion that oxygen is not required on all calls, maybe even some calls when you provide sympatientom relief, depending on the circumstances. Does MAC agree? Or should oxygen be applied to most patients, and in all cases that sympatientom relief is provided?

Question: I have some questions regarding supplemental oxygen. For a patient who requires oxygen, but is vomiting frequently is a nasal cannula an adequate oxygen delivery system, or should a Non Rebreather be continually removed an reapplied as necessary? Also I see a wide range of flow rates applied to the nasal cannula (anywhere from 2-8 lpm). What flow rate is most beneficial to a patient in a pre-hospital setting who requires supplemental oxygen via nasal cannula?