Respiratory Therapists Stingy with o2?

allnurses Guide · Jan 19, 2013

Were they do not resuscitate but for active treatment.

If DNR and death imminent in my opinion, increasing oxygen to improve saturations is just prolonging the inevitable, if they weren't distressed I'd have let them be.

samasch · Jan 19, 2013

Oxygen is a drug and with any drug if you give too much there could be adverse reactions. If the patient was near death anyway, why would you want to give them more of a drug just too make your numbers look good? Giving oxygen to a dying patient doesn't help at all. Instead of thinking that the RT was "stingy", you should trust the RT in their assessment.

machaix · Jan 20, 2013

And the patients were on bipap. They probably did not tolerate it, even with an increase of fio2. Intubation should have been done. But since they are on DNR, I don't think that was necessary...

prep8611 · Jan 20, 2013

Given the fact that the patient was hypotensive i severely doubt more fi02 would have fixed them

prep8611 · Jan 20, 2013

It's kinda like adding a fifth pressor on someone who is 60/30 post code who they just made dnr. I understand your thought but your paddling against a white water with a dingy. Your delaying the inevitable and the patient doesn't want to live on a vent for the rest of their life.

haji · Jan 21, 2013

One patient was DNR but we were trying to keep him going until his family got there. The next was a meds only code. So in both cases I had an intensivist in the room and we were giving pressors and code drugs. I don't like it when really sick DNR patients are brought into the icu and we try to resuscitate them. I don't see the point in it either, but its relatively common at my unit. So I try and keep them alive, short of CPR and intubation.

My point was that if someone is dying and you are trying to keep them alive, they need oxygen and there is no reason to resuscitate them on 40%.

prep8611 · Jan 21, 2013

My hospital doesn't do "med codes" or at least i haven't witnessed it thank god. If ur hearts not squeezing what's the point exactly for asystole or vfib patient to receive pressors? Beating a dead horse is all it is.... Kinda like increasing the 02 on bipap for a dying patient that needs to be intubated. Unless you were stalling for the family to get there i still see no point.

Altra, BSN, RN · Jan 21, 2013

Anyway, it just seems crazy to me, if somebody is hypotensive, desaturating, and barely alive, why be stingy with the o2? Has anybody else had this issue?

Why?

Because the patient is actively dying, and has expressed a desire to have heroic efforts limited.

One more thought: it may very well be acceptable at your hospital for you to change BIPAP and/or vent settings ... but I would be very careful about making sure there is an order for those settings.

K+MgSO4, BSN · Jan 22, 2013

they are dying............the O2 is not going to fix it if they are activly dying. Just prolong the time by a very short ammount.

Mully · Jan 22, 2013

If they are a DNR with advanced interventions like acls meds and such, then yes I agree the BIPAP should get turned up. Otherwise, the previous posters are right that there is no point.

I actually like the concept of DNR with meds and such, but not for any reason other than this - it helps the family start heading down the slope of letting the person die. It's a lot harder to go from a full code to a DNR comfort care only than it is to go from a full code to, pretty much full code except we're not going to break their ribs or put a tube down their throats. Obviously we as health care providers know that it's pretty close to pointless to push ACLS drugs if the heart's not beating, but I think it helps the family feel that they did everything for the person that they would want.

Esme12, ASN, BSN, RN · Jan 22, 2013

I my opinion...if death is imminent...100%FIO2 won't prevent them from dying....so if they are struggling there is NO REASON not to try to make them as comfortable as possible. Sometimes it is important to comfort the living by comforting the family. The patient is going to die.... we ALL know that...but if turning up the O2 will comfort the family then I see no problem with it...it' not like you are adding any expense to the bill.