Oxygen for the anxious patient

[Caffeinated RN]

Hello, all.I'm currently a nursing student working as an EMT for a BLS company. Several of my coworkers like to offer our patients oxygen for "comfort reasons." Most often, they will note a patient to be anxious on a non-emergency transport, and ask, "Would you like some oxygen?" despite having no other real reason to offer the O2.I have never felt this to be a reasonable justification for oxygen on a transport (and, of course, I am speaking in general terms, as each patient is different).I was surprised to learn that my manager supports this practice. I feel that offering 2 liters by nasal cannula is not really going to have any ill effect, as it only bumps up room oxygen by roughly 4 percent. But what really surprised me (and what prompted this post) was that my manager thought I should have offered a psych patient who was highly anxious and hyperventilating some oxygen "for comfort." Interestingly enough, in that same shift, I treated a separate patient whose hyperventilation due to anxiety was so bad that he was experiencing carpal pedal spasms. I could perhaps see oxygen justified only if the overall breathing rate could be slowed, but obviously, figuring out how to calm the patient is key.What are your thoughts on this? I am asking nurses this because i also have run into similar situations in clinical, and I see this mentality occasionally at other medical facilities.Thanks in advance!

[Been there,done that, ASN, RN]

Oxygen is a drug. It is not offered as..coffee, tea , or O2 ?

Transporting a psych patient does NOT require palliative oxygen administration.

That is throwing a band aid on a gushing wound. Treat the anxiety with the appropriate measures.

[amoLucia]

Question --- would the use of oxygen bump up the 'acuity' level of the pt (esp on non-emergency transport) and possibliy increase reimbursement $$$ when the agency does its billing? Or other statistics?

Am I becoming jaded in that I seem to be seeing $$$/budgeting at the root of most issues? Maybe I've been at this too long!

[SoullusRN]

BeenThereDoneThat,

With no anxiety medications on hand, just like when you get a gushing wound and don't have the tools to suture yourself shut, using a bandaid until the big guns are brought in is no longer an option..?

[That Guy, BSN, RN, EMT-B]

Why would they need more oxygen? They are already getting too much of it. Hyperventilation is a CO2 issue..... food for thought

[canned_bread]

My understanding is the hyperventilation is brought on by the body detecting the excess co2/abnormal pH levels, and thus by providing oxygen it might "mentally" make them think it's better, but ultimately its not healthy for the body. It would actually be making the situation worse. I would put the oximeter on them and show them that their sats are fine, and then try some breathing with them, to slow it down, make them focus. Seriously, oxygen isn't healthy if you don't need it.

[Susie2310]

My first thought was that I presumed your company has a physician medical director. I would have assumed that protocols written by an MD would address the question of when a patient should receive oxygen.

[Caffeinated RN]

Thank you for your comments. Several of your comments reinforce that I'm not crazy! Lol. To answer a few of the above question, we do not have a physician medical director at the company. We also cannot monitor pulse ox in the state of CA as an EMT. And I used the hyperventilating patient with the spasms asan example why you wouldn't go straight to oxygen, since the problem was deal with CO2. Thanks,again!

[PRNketamine7, BSN, RN]

The hyperventilating patients need a brown paper bag, not O2... Correct?

[EMT-newbie]

Just a non-professional thought but for people not hyperventilating just the offer of O2 and the presence of the mask or nose tubes may have a calming effect because it's seen all the time on TV, you know the scene where the patient flies into the ER and immediately gets an oxygen mask and is OK or gets one at the scene on the ambulance and the hero knows that the guy in there will be OK.

Appearances, expectations and placebo effect can trump reality sometimes.

[That Guy, BSN, RN, EMT-B]

The hyperventilating patients need a brown paper bag, not O2... Correct?

They need to slow their roll more than anything else.