You arrive on scene for a patient with a painful broken hand. The first responder, as he is trained, has a nonrebreather on the patient. You thank him for the report, and then take the nonrebreather off and say to the patient, we’re going to see how you do without this for a minute.
Sometimes I see in the first responder’s eyes the hint of a reprimand. Am I quietly putting them down for putting on the 02 or am I a bad medic for taking it off? The scene plays out over and over every day. Sometimes I have to tell them later that I know they are just following their protocols, but I need to assess the patient off the 02, and I don’t mean against them when I take it off the patient.
But who ever came up with this idea of putting a nonrebreather on everybody, respiratory distress or not?
I got into a discussion once with one of my preceptees about their putting a nonrebreather on a patient who wasn’t in respiratory distress. Why? I asked. because it will make them better, he answered. Because that’s what we’re taught. And besides oxygen can’t hurt.
Yes, I’ve heard that before, but I’ve been hearing and reading other things as well. Here’s the latest:
Now this is just one study (one of a growing number) and I’m certainly in no position to advocate not giving someone in respiratory distress or arrest high-flow oxygen, but can’t someone authorize the first responders to ease up on it instead of telling them to continue putting high-flow oxygen on everyone.
Someone is making a lot of money selling oxygen and oxygen masks.
Here are some of the (conflicting?) things the American Heart Assosiation has to say about oxygen.
Oxygen by first responders:
There is insufficient evidence to recommend for or against the use of oxygen by a first aid provider (Class Indeterminate), and concern exists that oxygen administration may delay other interventions.
Oxygen by basic life support and advanced life support:
To improve oxygenation, health care providers should give 100% inspired oxygen (FiO2 + 1.0) during basic life support and advanced cardiovascular life support as soon as it becomes available
Oxygen for Asthma:
Provide oxygen to all patients with severe asthma, even those with normal oxygenation. Titrate to maintain SaO2 >92%.
Oxygen for stroke patients:
Both out-of-hospital and in-hospital medical personnel should administer supplementary oxygen to hypoxemic (ie, oxygen saturation <92%) stroke patients (Class I) or those with unknown oxygen saturation. Clinicians may consider giving oxygen to patients who are not hypoxemic (Class IIb).
Oxygen for people having chest pain:
EMS providers may administer oxygen to all patients. If the patient is hypoxemic, providers should titrate therapy based on monitoring of oxyhemoglobin saturation (Class I).
Administer oxygen to all patients with overt pulmonary congestion or arterial oxygen saturation <90% (Class I). It is also reasonable to administer supplementary oxygen to all patients with ACS for the first 6 hours of therapy (Class IIa). Supplementary oxygen limited ischemic myocardial injury in animals, and oxygen therapy in patients with STEMI reduced the amount of ST-segment elevation. Although a human trial of supplementary oxygen versus room air failed to show a long-term benefit of supplementary oxygen therapy for patients with MI, short-term oxygen administration is beneficial for the patient with unrecognized hypoxemia or unstable pulmonary function. In patients with severe chronic obstructive pulmonary disease, as with any other patient, monitor for hypoventilation.
Oxygen for Pediatric Basic Life Support:
Despite animal and theoretic data suggesting possible adverse effects of 100% oxygen,82–85 there are no studies comparing various concentrations of oxygen during resuscitation beyond the newborn period. Until additional information becomes available, healthcare providers should use 100% oxygen during resuscitation (Class Indeterminate). Once the patient is stable, wean supplementary oxygen but ensure adequate oxygen delivery by appropriate monitoring.
I was teaching a protocol rollout class the other day talking about how we are now doing things we thought were bad (morphine for abdominal pain) and no longer doing some things we thought were good (Hi-flow fluid recusitation in trauma). Who would have thought oxygen might be harming people?