O2 for Unresponsive Pt

amysiuk · Mar 17, 2016

You weren't wrong. Unconscious patients always need oxygen. They also can't protect her airway, because they are unconscious. Most EMS departments have ET CO2,if not all. Pulse ox symmetry only tells you about the patients oxygenation, gives you no information in reference to their ventilation. I probably wouldn't question them, I would assess the patient, and let that guide your treatment. Next time you go to work, hold your breath as long as you can, and check your pulse ox........ It will be above 95%. As soon as you stop ventilating/breathing the ETCO2 will most likely be above 45.

Guest219794 · Mar 17, 2016

You weren't wrong. Unconscious patients always need oxygen. They also can't protect her airway, because they are unconscious. Most EMS departments have ET CO2,if not all. Pulse ox symmetry only tells you about the patients oxygenation, gives you no information in reference to their ventilation. I probably wouldn't question them, I would assess the patient, and let that guide your treatment. Next time you go to work, hold your breath as long as you can, and check your pulse ox........ It will be above 95%. As soon as you stop ventilating/breathing the ETCO2 will most likely be above 45.

This sounds like a good rationale For monitoring ETCO2, as well as ventilation.

And, yes, when ventilation is inadequate, ETCO2 drops before SPO2.

But how does giving supplemental oxygen benefit this patient?

CraigB-RN, MSN, RN · Mar 17, 2016

The Pt probably did not need supplemental O2. What you didn't say was if the EMS unit had ETCO2.

Oxygen isn't a panacea. It's actually a caustic medication, that should never be given indiscriminately. In this patients case, I'd be more concerned about her airway, not so much her oxygenation. Adding 100% O2 isn't going to be very helpful if she looses her airway. Some of the old rules we used to use to determine this kind of stuff have been shown to be not as useful as we thoughts. There is a percentage of the population who doesn't have a gag reflex for starters. On the other hand the rule of GCS of 8 or less intubate, left many a patient who should be intubated, without a secured airway.

What the patient needed, was a good assessment, evaluating airway, tidal volume, and oxygenation status. Pulse Ox, ETCO2 and maybe depending on what you find, an ABG.

If there is a change in her ventilation status, a case can made for supplemental O2 delaying you seeing change in her status.

Another thing to to keep in mind, once you intubate the patient and place on a ventilator, resp will rapidly reduce the FiO2 to 21% or room air.

myhoagie02 · Mar 17, 2016

The Pt probably did not need supplemental O2. What you didn't say was if the EMS unit had ETCO2.

Only critical care has such monitoring. This wasn't a CC unit.

chivon101 · Mar 17, 2016

most ERs should have it or your RT can used a portable ETCO2 monitoring. I think most paramedics used ETco2 monitoring in the field these days

Editorial Team / Moderator · Mar 17, 2016

Pulse ox symmetry only tells you about the patients oxygenation

I was sitting here going, symmetry? Then I said it out loud... Pulse oximetry. Lol. I need more coffee!!

CraigB-RN, MSN, RN · Mar 18, 2016

Just an aside.

It's helpful to have actually vital signs when having these discussions. VS WNL is a null statement that doesn't really tell anyone anything and medical legally not worth the ink used to write it. By giving actual numbers it gives responders the ability to get a better picture in their head of what the patient looks like.

myhoagie02 · Mar 18, 2016

Just an aside.
It's helpful to have actually vital signs when having these discussions. VS WNL is a null statement that doesn't really tell anyone anything and medical legally not worth the ink used to write it. By giving actual numbers it gives responders the ability to get a better picture in their head of what the patient looks like.

Well, CraigB-RN, unfortunately my charting doesn't carry over here on this forum and memory fails to provide me with precise values. I thought by stating that VS were WNL was sufficient given that there are already well known parameters we learned about in school. Evidentially I didn't paint as thorough of a picture as I thought. However, you provided a very useful information earlier in the thread. Many thanks to you and the others for your responses.

CraigB-RN, MSN, RN · Mar 18, 2016

Wasn't trying to slam you. Sorry if it came across that way.

Was just a comment about painting a picture. Cheap example is an athlete. RR of 12 and HR of 45 is probably WNL for Lance Armstrong. But for me it would mean I took to much B-Blocker.

bgxyrnf, MSN, RN · Mar 21, 2016

Normoxic patients do not need supplemental oxygen. In fact, mounting evidence indicates that it can be harmful in some circumstances (for example, it's recommended in UpToDate that normoxic STEMI patients not be given supplemental oxygen).

If the patient is unresponsive, they need to be intubated but that is to protect the airway, not to provide supplemental oxygenation.

heinz57 · Mar 21, 2016

most ERs should have it or your RT can used a portable ETCO2 monitoring. I think most paramedics used ETco2 monitoring in the field these days

The Paramedics might have it but around here in the city they only use if using RSI and intubating with a ventilator. I have never seen them use it on a non intubated patient. If they use a King airway, they don't use ETCO2. I saw the same when I was in Texas. Rarely was it used although I think most of the EMS ambulances had it. They have their own set of rules in Texas where they don't have to follow protocols unlike EMS in other parts of the company.

Adding oxygen would depend on the quality of respirations and work of breathing. If a patient is breathing rapidly to maintain 98% on the SpO2, oxygen probably would be beneficial. ETCO2 also depends on cardiac output and metabolic status.

The other situation where O2 could make a difference is in the face of severe sepsis.