Chronic COPD'er, 1 lung, 02 @ 6L/min. What would you do? - page 7

I got a call to go see one of my HH patients, who I am very familar with, because the family reported that her/his 02 sats were hanging in the 70's all day and even though she/he was not SOB they... Read More

  1. by   Altra
    Quote from morte
    MLOS, this patient was NOT SOB....
    Quote from MLOS
    I'm a little bit baffled why perceived "respect" or perceived lack of respect is being debated when the issue is treatment for an acutely hypoxic patient.
    The issue is hypoxia, not whether or not the pt. is experiencing the sensation of SOB.
  2. by   angel's RN
    Ya Know-- I Realllllly Think That The Pt. Could Avoid The Whole Situation By Either Becoming A Dnr, Or Accept The Emt's Judgement. I Work In Ccu, And I Really Think That, Since (1), There Was Enough Of An "emergency" To Call 911, And (2) The Ems Does This Every Day, Many Times A Day, That She Would Know What She Is Doing. If The Patient Did Not Want To O2 (and You Said That You Did Not Want), All She Would Have Had To Say Is "go Away, I'll Go On My Own!!!! Hope That The Patient Is Doing A-o.k.!!!!!
  3. by   chip193
    Quote from DutchgirlRN
    That's how I was feeling about it. I wish the family would of have taken her in the car but they refused.
    Would it have been better if the patient had decompensated in a car with no one with medical training or equipment?
  4. by   Antikigirl
    Okay lets look at a little bit of the old A/P here...one lung doesn't do much for the slow add up of CO2 or even an acute case. Remember, it is the action of the lungs and adrenals first that help with acid base..lungs being foremost for acute. Okay one of those...oopsie, how are those adrenals that have been compensating for the one lung...proably exausted and not working top notch....this woman was satting down as I call it, and yes..a vent was more than likely needed as TREATMENT of the CO2 that had been building up....she needs that extra to compensate! SO her being on a vent isn't ment as a torture, a mistake, or anything of the sort...it is a TREATMENT to save her life. 70's! Yep...she was obviously acidotic...if you think it was in error check out her arterial blood gasses if you can! That my friends is simple a/p! That always overrides the fear of hypoxic drive which so many nurses others are in fear of...so much they overide many vital treatments in acute emergencies!

    ALSO...A paramedic does NOT have to listen to the RN as far as taking orders! They take orders from protocol and a call in to their acting MD. So you may have felt ingnored, but they don't have time to hear the old "don't bump up the O's" from yet another nurse...sadly it has become typical and they let it in one ear and out the other because they don't have time to banter with a nurse...they have an acute emergency to deal with and all their brain cells need to be working on JUST THAT! Trust me, they heard you...they just didn't have the time to argue the fact.

    Another reminder...unlike nursing, a patient in the back of an ambulance for the one and ONLY time in their medical situation will have a trained professional at their side doing NOTHING but monitoring them closely with only THEM in mind for 15 or more minutes! This is the only time they will ever really get this close and scrutinizing care...and most paramedics/emts have CO2 detectors and know signs/symptoms of hypoxia or hypercapnia better than most nurses (no offence towards those that know it well...but a home health RN may not know as much as ohhhhh say a paramedic!!!). And get this...they have the equipment to TREAT IT on the spot!

    Like my hubby..a 13 year paramedic says "I will never withhold O2 to a hypoxic patient, and if I note there is a probelm I simply reduce the rate within seconds and can treat that...we have the technology (LOL on the last part)". HE also will admit that so many MD's or RN's think that all they do is plop the patient in the back and both medics go in the front and drive.....ummmmmmm NO! Why all the equipment back there huh?

    Another fact, Paramedics and EMTs have a TON of CME they must do yearly...they are typical more up to date on the latest treatments in EMS than any of us! What CME do we have? Yeah...nada or so little it isn't funny!

    And one more thing since I am on a bit of a soap box...don't anyone DARE send a patient into an ER when they are just trying to avoid a wait time! This patient was serious enough to go in this way...but I see LTC's sending in their patients for basically NOTHING by ambulance just to avoid wait times...there is NOTHING that makes them more special than anyone that has waited out in an ER room for hours so they can be treated! It is people like this that send valid patients that can't wait back home to become even more seriously injured/ill and admitted for something that could have been fixed easily! I do know that many LTC's do not have someone to drive a patient in, and need to use ambulance...but try to avoid that...it is killing our EMS and taking them out of service for real emergencies! A recent hit and run here showed that...poor 7 year old girl died because it took so long to get an ambulance because they were all busy with what we call BS patient calls and they had to pull one in from a great distance...My hubby was furious because he was nearer, but had to take in a little old lady with a sore foot into the ER! GRRRRRRRR!!!!! (it was a bunion by the way...nothing a MD or pediatrist could have seen and DX!!!!, all because the woman wouldn't stop wearing closed toe shoes...this was time number 4 for her going in for this in one year!!!!).

    WHen paramedics or EMT's turn up my O2..I know they have the skill, protocol and sense to monitor closely and intervene quickly and I trust them! They can handle the situation far better than I, and get the patient to an ER for further treatment...again which I can't do. I trust them as I would trust other medics...they are a part of my team, and have the same mindset...to help patients to the best of our ability given our level of skill and education, and paramedics get much more than anyone gives them credit for!!!!!!!!

    (oh hint...report them if you must or feel you should, their bedside mannor may need work...however, I would return the favor by pointing out the pulse ox readings and how long you let that go before calling 9-11 or even calling the MD??? *wink* ).
  5. by   muffie
    hey lady, are you married to one or something ???? lol
  6. by   Antikigirl
    Gee however could you tell...not to mention I am a paramedic wannabe! LOL!!!!!!!!! Huggles Muffie!
  7. by   morte
    can you please point me in the directon of the chapter in law that says a paramedic is the only med prof that doesnt have to respect the word .....NO......
  8. by   Altra
    Morte, let's think about the relationship between mentation & hypoxia.

    Then, let's think about whether or not you could defend your decision not to increase O2 on a patient w/SpO2 of 73% with the statement, "the patient refused."
  9. by   morte
    it doesnt make any difference....unless you are going to get a judge to come to the house,....the op knows this patient and gave no indication there was any gross change in mentition.....you cant impose your will on someone because you think you are right
  10. by   Cattitude
    reading this whole thread has really opened my eyes. i do deal with paramedics on occasion especially when i have really sick pt's at home that go back and forth to the hospital.

    thank goodness i have had really courteous professional dealings so far. they do listen to me as asfar as requesting medical hx, present situation, i also provide them with an updated med. sheet to bring to the hospital. i've never been ignored or treated like the hh nurse that doesn't know anything. i let them do their thing and have helped them when i can (moving the pt, etc).

    i have never called ems and left before they got there. that is the poorest of nursing care. but as stated in previous posts, there is incompetency in every profession. no one is immune.
  11. by   Altra
    Quote from morte
    it doesnt make any difference....unless you are going to get a judge to come to the house
    That is precisely the point. If there were to be a bad outcome and subsequent litigation, the judge/jury will not have been there at the house to see the patient. What they are going to see is that the patient had a recorded SpO2 of 73%, seriously hypoxic by any clinical standard, and yet O2 was not increased.
  12. by   morte
    Quote from MLOS
    That is precisely the point. If there were to be a bad outcome and subsequent litigation, the judge/jury will not have been there at the house to see the patient. What they are going to see is that the patient had a recorded SpO2 of 73%, seriously hypoxic by any clinical standard, and yet O2 was not increased.
    are you purposefully misunderstanding?! my mention of a judge was to judge competence.....IF one were at the house (judge) he/she would not be able to preside in a case concerning patient.....you still havent addressed my request for citation of law about paramedics being the only med prof that are aloud to ignore a patients clearly stated NO, i have to presume that you cant.....as i figured......
  13. by   rnin02
    Quote from morte
    are you purposefully misunderstanding?! my mention of a judge was to judge competence.....IF one were at the house (judge) he/she would not be able to preside in a case concerning patient.....you still havent addressed my request for citation of law about paramedics being the only med prof that are aloud to ignore a patients clearly stated NO, i have to presume that you cant.....as i figured......
    I think I would "ignore a patient's clearly stated NO" if they had an pulse ox of 73%, even if the other people present stated the pt's mentation had not changed simply because I have to use my best judgement in treating this patient during an emergency and I have no prior knowledge of this patient's mentation. While personally I would listen to the family and HHN report on the patient, including history, etc...I would still have to use my best judgement. And I'm sorry, but it's much easier to defend putting on/turning up O2 in this case then to defend doing nothing but providing a ride to the hospital. Maybe there's no specific "law" about paramedics not having to listen to a "NO" from a patient, but you have to use common sense and provide care that you judge to be best.

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