02 10L via nonrebreather...always applied if possible MI/Cardiac issue?

[NotFlo]

I work in rehab/LTC. Had a pt. today complaining of chest pain, hx. of MI, COPD, CHF etc.

Vitals all well within normal limits (apical rate 60), O2 Sat was 99 percent on one L when initially checked.

Pts. MD in building, checked pt and wanted pt sent out. Gave nitro x 3, O2 sat went between 94-99 percent (just kept oximeter on finger the whole time). I ended up bumping up the O2 but kept pt. on nasal cannula.

Normally, we do get a big tank and put pt. on 10L via non-rebreather for possible cardiac issues, resp. distress, etc. but I honestly didn't see the need to do that and thought it might be counterproductive with the COPD etc.

Should I have put pt on the 10L non-rebreather in this situation? Should this be something automatically done while awaiting EMS? Of course, EMS made me feel like a complete idiot for leaving her on the NC on a lower liter flow.

[KellyCCRN]

If the pt had COPD it would have been counterproductive to place the pt on high flow oxygen and could have potentially knocked out the drive to breathe especially if the pt is a co2 retainer. Personally I believe you made the right choice.

[vampiregirl, BSN, RN]

As I've discovered as a nursing student is that there are some huge differences between nursing and EMS. Oxygen being one of them. My local EMS protocols call for high flow O2 on cardiac or suspected cardiac patients, regardless of whether they are having difficulty breathing. I've actually asked about why we do this for COPD patients... the response I got was that the benefits (oxygenation) outweight the risks (decreased respiratory drive) since usually EMS contact is brief.

If you have EMS personnel give you a hard time about the nasal cannula, it wouldn't hurt to remind them that your facility has protocols, just as they do. Hopefully, they can appreciate this logic. At least where I am an EMT, there are a couple of protocols that I don't agree with, but I follow regardless.

[MN BigJ]

We put 2-4L NC on STEMI pt's. No real reason to go crazy with it. Even a small amount of extra Os help. Many people with cardiac chest pain get some relief with a small amount of O2 but no more relief by increasing it.

[northshore08]

You were right. According to your description, pt was not in any respiratory distress. No need for hi flo O2; and COPD hx was another point in your favor.

EMS gives O2 short term and doesn't have to deal with longer term consequences like bagging the COPD pt they hyperoxygenated. If sats were 99% on 1liter, you were okay.

[leslie :-D]

hi flo o2 used short term, will have little effect on copd'ers.

if you notice a change in ms, then shut it down.

but for the most part, it's perfectly ok to crank it up on a temporary basis.

leslie

[GrumpyRN63, ADN, RN]

I think you were correct, I only use a non-rebreather when the pt crashes and tanks their 02 sats and its the only way to get them oxygenated. Your pt was sating fine, no need to go crazy, I may have bumped them up a little 2-4L, but that's about it.

[mpccrn, BSN, RN]

even with actively infarcting patient we only give enough O2 to keep their sats >95%......whatever it takes:smokin:

[mcknis]

We actually had a pt last night tanking her SpO2 and needed a NRB to get her back up to norm. Our pulse ox was reading in the 50-60 range (which i never trust less than 70 on machines), was retaining CO2 and very lethargic so she needed bumped with a NRB. we were going back and forth between NC and NRB, but none the less, without going to a BiPAP or vent, that was the best we could do at the time.