Do you admister oxygen on your floor to a pt complaing of chest pain?

Nurses General Nursing

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I just have a questions that has been bothered me for a long time..Many nursing books talk about performing basic nursing interventions for a chest pain such as oxygen,beta-blocker,nitro (I guess I'm refering to the angina protocol here) I was wondering if some of the interventions are only specific to an ER such as a beta blocker,oxygen or asprin,I'm slightly confused I guess since when I used to work on a step-down unit when ever we used to get a chest pain patient they just gave nitro but I havent see the oxygen,beta-blocker or aspirin for that matter.I also read in the textbook that oxygen should be given as first line defense.

Chest pain is usually caused by lack of O2 to the heart muscle so the solution is O2 therapy first.

I work Tele, when a patient complains of chest pain this is what I do...

1. O2 at 2L NC.

2. Morphine/Nitro SL.

3. Stat EKG.

4. Stat Cardiac Enzymes.

5. Notify physician.

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Specializes in Emergency, Critical Care (CEN, CCRN).
Recent evidence has shown that oxygen can be detrimental to a patient whose O2 saturation is greater than 95%. The AHA has several published studies regarding the use of oxygen on chest pain and stroke patients.

Two statements don't seem to go together - yes, the AHA has published a lot of papers on ACS and CVA/TIA, but none stating that oxygen is harmful when SpO2 is greater than 95%. Currently (as of 2009), the AHA states that supplemental oxygen is a C-level evidence-based treatment option in the first six hours of an ACS-related event. Can you please point me to the study showing damage above that 95% SpO2 cutoff?

Having just run a quick version of the same search myself, I found a total of three RCTs on oxygen in ACS, one dating from 1976 (!). Everything since seems either to be A) a meta-analysis, B) possessing poor predictive or statistical power, or C) all of the above. Moreover, all those studies were looking at high-flow oxygen provided by mask, not the nurse's standing-order 2L by nasal cannula. Has anyone actually looked at whether there exists an effect of greater harm at higher FiO2 levels, and if so where does the injury point begin? 2L? 4L? 6L?

This is an interesting question, and I'd be curious to see if there's any research out there on oxygen use that's specific to nursing practice.

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Specializes in ER, ICU, Education.

O2 is the first line of treatment for chest pain, then it's followed by drugs.

Always remember the basics first!

A, B, C's!

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Specializes in Cardiac ICU.

I usually try to do a 12-lead EKG before giving nitrates, in case this is a real chest pain it would show changes on the 12-lead. The nitrates could immediately change the initial rhythm.

Nitrates I usually give but I don't use it if the patients' BP is already low. I just give the morphine in that case.

Oxygen is usually a good idea.

I guess it all depends on your patient's condition and allergies.

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Specializes in medical, telemetry, IMC.
chest pain is usually caused by lack of o2 to the heart muscle so the solution is o2 therapy first.

i work tele, when a patient complains of chest pain this is what i do...

1. o2 at 2l nc.

2. morphine/nitro sl.

3. stat ekg.

4. stat cardiac enzymes.

5. notify physician.

same here!!

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Recent evidence has shown that oxygen can be detrimental to a patient whose O2 saturation is greater than 95%. The AHA has several published studies regarding the use of oxygen on chest pain and stroke patients.

So how would you go about administering an oxygen to a pt then? Would you use pulse oximetry first to determine the oxygen saturation level and then based on results administer the oxygen or hold it.

Also someone else mentioned that morphine decreases the work of breathing but I also read that it relieves the pulmonary congestion

Sitting patient up and administering 3-4 liters of oxygen and then wait few minutes sounds like a good intervention to me.:up:

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Depends, if I am dealing with a RVI or hemodynamic instability, I'll use fentanyl.

And why would you use fentanyl for hemodynamic instability? Cause it doesnt lower blood pressure?

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Specializes in OR, MS, Neuro, UC.

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Sitting patient up and administering 3-4 liters of oxygen and then wait few minutes sounds like a good intervention to me.:up:

Just make sure the patient doesn't have COPD if you go above 2l.

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Sitting patient up and administering 3-4 liters of oxygen and then wait few minutes sounds like a good intervention to me.:up:

Just make sure the patient doesn't have COPD if you go above 2l.

That is true,I guess it is always safer to go with 2 liters,should I always check their pulse ox result?>

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And why would you use fentanyl for hemodynamic instability? Cause it doesnt lower blood pressure?

It can lower blood pressure in some cases, but this is much less likely with fentanyl compared to a medication like morphine.

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Sitting patient up and administering 3-4 liters of oxygen and then wait few minutes sounds like a good intervention to me.:up:

Just make sure the patient doesn't have COPD if you go above 2l.

Why? Trust me when I say the patient will not suddenly stop breathing, loose their head, and have their cyanotic head roll down the hallway to spontaneously combust in the med room if you give more than 2 LPM. I understand this is contrary to the horror stories nursing instructors tell nursing students before tucking the said students into bed for the night. If these instructors knew any better, they would be teaching reality instead of continuing to produce new nurses educated to loose the plot over the hypoxic drive scarecrow.

Sorry, to this day I continue to have heated arguments with ignorant ER nurses over my management of patients who happen to have a COPD diagnosis somewhere in their chart.

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should I always check their pulse ox result?>

checking the pulse ox is part of the protocol as we put someone on the monitor - but just because someone has an SaO2 >93% doesn't mean we'll take them off of O2 if they are experiencing chest pain.
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It can lower blood pressure in some cases, but this is much less likely with fentanyl compared to a medication like morphine.

Just make sure the patient doesn't have COPD if you go above 2l.

Sorry, to this day I continue to have heated arguments with ignorant ER nurses over my management of patients who happen to have a COPD diagnosis somewhere in their chart.

It doesn't mean that they are ignorant- it just means that they know no better.

No one ever listens or wins in a heated argument anyways. Try teaching them calmly and if you have to, back it up with supporting facts and not because, "I said so.". ( if that is the way of things).

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