The correct way to send a patient out to the hospital...

[lvnnars1]

just for clarification. regarding LTC facilities. ok, lets say you have a patient having SOB you check the O2 sat. and it's 84% you give 2 liters of o2 via NC and it's about 86% now, pt. is a code, patient is a&o X3 how would you go about sending this patient out? would you first get an order from the MD first to send the patient out, or do you use your nursing judgement and send out patient then call the doctor after the ambulance picks him up? do you call 911 at all? curious to see your answers.

[CT Pixie, BSN, RN]

NRB in an LTC? Not in any I've worked in. Your choices are a nasal cannula or a neb tx mask :) I've brought this up several times in staff meetings and always get "that's a great idea" but NEVER do they follow through.

As for the 911 lights/siren, in my area, no matter who is calling 911..the ambulance goes code 1 (lights and sirens). The caller, regardless of them being a nurse in a facility or a private citizen, cannot ask nor dictate how the ambulance comes.

[metal_m0nk, BSN, RN]

Considering that oxygen has very, very, very little to do with acid base, I would say THIS is poor nursing judgement.

Wooow....

You're kidding me, right?

Do me a quick favor, okay?

Explain respiratory acidosis/alkalosis.

Better yet, what is produced during the process of cellular respiration in the absence of oxygen? Brought to an extreme, what does this result in?

[usalsfyre]

Wooow....

You're kidding me, right?

Do me a quick favor, okay?

Explain respiratory acidosis/alkalosis.

To massively oversimplify things, respiratory acidosis/alkalosis is related to CO2 and resultant ventilation. NOT oxygen/hypoxia. It's possible to have a 100% SaO2, a Pa02 of 400 and still have massive acidosis (granted usually metabolic in nature and often a gap acidosis). Think hydrogen ion (you know the big H in pH), and learn a bit about the bicarbonate buffer system.

If your referring to hypoxic drive, very, very few patients with this condition actually are living among us. Most of them never make it out of the pulmonary ward of an acute care facility.

Do me a quick favor, before you start giving out bad info/allowing people to become hypoxic by withholding oxygen learn a little about the respiratory system. MMMMKAYY

[metal_m0nk, BSN, RN]

To massively oversimplify things, respiratory acidosis/alkalosis is related to CO2 and resultant ventilation. NOT oxygen/hypoxia. It's possible to have a 100% SaO2, a Pa02 of 400 and still have massive acidosis (granted usually metabolic in nature and often a gap acidosis). Think hydrogen ion (you know the big H in pH), and learn a bit about the bicarbonate buffer system.

If your referring to hypoxic drive, very, very few patients with this condition actually are living among us. Most of them never make it out of the pulmonary ward of an acute care facility.

Do me a quick favor, before you start giving out bad info/allowing people to become hypoxic by withholding oxygen learn a little about the respiratory system. MMMMKAYY

Firstly, you're talking to a biologist.

Secondly, it is apparent that you've never heard of the Haldane effect and have never seen an oxyhaemoglobin dissociation curve.

When oxygen is present, hemoglobin has far less capacity to accept "the big H in pH".

MmmmmmKay?

[usalsfyre]

Firstly, you're talking to a biologist.

Had I known, I would have expected better.

Secondly, it is apparent that you've never heard of the Haldane effect and have never seen an oxyhaemoglobin dissociation curve.

The Haldane effect is not really clinically significant in the emergent setting. And acid base affects the oxyhemoglobin dissociation curve, not the other way around. Hypoxia kills far faster than any negative effect on acid/base. No where are you going to find an argument that supplemental oxygen is going to somehow make hypoxia worse.

Please go back to the lab, and let those of us who treat patients daily talk about clinically relevant topics.

[metal_m0nk, BSN, RN]

Please go back to the lab, and let those of us who treat patients daily talk about clinically relevant topics.

If you're going to perform in a clinical environment where you are responsible for peoples lives, it is important to actually understand the scientific principles that drive your interventions.

You stated clearly that:

oxygen has very, very, very little to do with acid base

You are quite clearly wrong.

[usalsfyre]

If you're going to perform in a clinical environment where you are responsible for peoples lives, it is important to actually understand the scientific principles that drive your interventions.

Agreed, but it's also important to understand which of those scientific principals have bearing on clinical practice. If your withholding O2 from a hypoxic patient because of the Haldane effect you've obviously lost sight of that.

[metal_m0nk, BSN, RN]

Agreed, but it's also important to understand which of those scientific principals have bearing on clinical practice. If your withholding O2 from a hypoxic patient because of the Haldane effect you've obviously lost sight of that.

I said nothing about withholding O2 from a hypoxic patient. If you can show me that your comment that O2 has very, very, very little to do with acid base was intended to illustrate that point, I'll concede the point. However, the nature of your comment was not so specific. It made a very broad, exclusive, very easily misinterpreted statement. There are a lot of students on this board, a few who might be struggling with these concepts in their nursing programs. It's better to say that the science behind respiration and blood pH balance is complicated and explain why than to make blanket statements that provide a barrier to true understanding.

Nothing wrong with providing clinically relevant information to back your clinical assertions.

Something wrong with obfuscating scientifically relevant information to back your clinical assertions.

[CrunchRN, ADN, RN]

Insteresting fight, uhm, I mean discussion.

I do not work actue care, but I remember back in school 18 years ago we were always told never to give COPDers above 2l oxygen. I think it was felt at the time that they would retain C02? And this would eventually shut down the respiratory drive? Very vague memories about the reason.......

What is the current thinking on COPDers ( I am asking the current acute care standard)?

And please gawd do not start on the frigging Krebbs cycle. I still remember that with hate!

[nurse2033, MSN, RN]

im talking about LTC..

also what type of situations do you use a "non siren ambulance" (not 911)?

If you feel this is an emergency then you should call 911 and they will come emergent. If it is not an emergency, don't call 911 but a private ambulance service and ask for a non-emergent response. If you don't know whom to call you should find out what agencies service your area. As another poster noted you should troubleshoot the situation yourself and try to figure out what the problem is, then the solution will be clearer. If the doctor doesn't respond in a timely fashion you should do whatever you think best to the benefit of your patient.

[metal_m0nk, BSN, RN]

And please gawd do not start on the frigging Krebbs cycle. I still remember that with hate!

Haha!

You are not alone in that. Biologists hated it too. Well, this one did at least. But it was all but pounded into my brain.

[hope3456, ASN, RN]

I am a RN in a LTC. Last night a s/p ORIF rehab to home resident was finishing her therapy session with the PTA and the PTA assisted her onto the toilet. The resident became unresponsive and slumped over and the PTA started screaming hysterically. A CNA came and got me but also summoned the attention of the ADON, social worker,ect. When I got there she was slumped over but had a steady pulse, resps, and 'came to' with sternal rub. We got VS which were stable and she was AOx3. The ADON was like omg we need to send her to the ER right away.....i didn't want to get in trouble so i sent her out via EMS.

She came back 1.5 hrs later with the diagnosis which i suspected - vasovagal response. She had a complete cardiac workup in the ER which was benign. I did notify the resident's personal physician who was like 'you already sent her out?' I did think it was unnecessary but my DON and ADON have repeatedly told me to 'err on the side of caution.' She just had orders to 'encourage fluids.' I think a MD notification and close monitoring would have been sufficient.

Oh and the EMS informed me that they have some new regs starting this year - they gave them to me. I just briefly glanced at them but it looks like they are trying to cut down on these unnecessary LTC transports by making us fill out more forms and they stated that they cannot bill medicaid/medicare unless it is truely an emergency - not that i blame them.