[Sdiver]

This is a question I have for the MD's on the board, not so much the Deltas here, but if an 18D can answer this question, I'm all ears.

Is there a medical reason why MDs (or RNs for that matter) don't increase O2 on pts c/o CP?

As some of you may know, I work for AMR here in Denver and we have the contracts for various medical/insurance companies. These companies have various clinics around the Denver metro area, and many is the time we are called to these clinics for pts c/o CP, and we walk in and the pts are only on Nasal Cannulas at 2L. Is there a medical reason, or Even a "fear" of putting a pt with CP on a NRB?

Sure, the pt may have good O2 sats, but still c/o CP.

These clinics may have started CP procedure, O2, 324 ASA, Nitro, even MS, PTA, but these pts are still on NCs when we get there.

I'm going to give a couple of examples of 2 calls my Medic and I ran yesterday and then again today.

1st call:
Dispatched to a clinic for a 52 y/o male c/o CP. Arrive on scene to find pt c/o 6 out of 10 CP, radiating to L shoulder and in between shoulder blades. Pt AAO x3. Diaforetic with slight nausea. Pt has Hx of MI. One in 2002 and another in 2004. Stents placed both times. States the pain he is experiencing is the same as before.

PTA.....Line established, 18g L AC. Pt started on 2L O2 NC, 324 ASA 0.4mg Nitro X3, Nitropaste L Pectoral and 4mg MS. 12 lead shows 2mm elevation in Leads 2 and 3, as well as in aVF and aVR.

Pt transferred to our cot, and the 1st thing I do is put Pt on NRB at 15L.

We wheel Pt out to ambulance and load. Code 3. Cardiac Alert.

Time taken since I put Pt on NRB at 15L to when we get him in the back of the rig, aprox 6 minutes. Pt now states pain at 5 out of 10.

My Medic gives Pt another 10mg of MS while in route.

Transport time....aprox 12 minutes to Hsp. While in ED, Cardiologist confirms Cardiac alert and sends Pt to Cath Lab.

Door to balloon........9 minutes.

2nd call:
Called to a clinic for a 68 y/o female c/o CP. Arrive on scene to find Pt c/o 5 out of 10 R sided CP, non radiating. Pt also confirm to have pneumonia. States she's had breathing problems for past 6 days. R base crackles upon exhalation.

Vitals PTA.....BP 148/84, Rate 88, Resps 20, O2 stats 94 on 2L NC. Pt given 324 ASA.
NO LINE ESTABLISHED. Multiple attempts by clinic. So they were unable to give Nitro.

Transferred to cot. Got Pt on monitor. EKG show SR with occasional PACs.

I put Pt on 15L NRB. 5 minutes later, ectopy is gone. But 12 lead shows inverted T waves in leads 2, 3, V1, V2, aVF, and aVR. There is no ST elevation, so no Cardiac Alert called.

Get Pt out to ambulance. Start IV. 22g L forearm. (Only spot available to me after clinics multiple attempts). Pt given 0.4 Nitro SubQ.

Begin Transport. Non-emergent to HSP.

Medic gives 0.4 Nitro x2 SubQ. Pt claims pain increasing after each Nitro given. After 1st Nitro, pain at 7 out of 10.
2nd Nitro......8 out of 10
3rd Nitro.....9 out of 10

No EKG ectopy noted.

Stepped up to Code 3. Diverted to closest Hsp. Medic gives 10mg MS by the time we pull into ED.

*Pt sat in clinic for aprox 30 minutes before being seen. Sat another 25 minutes while staff attempted to start line before we were called. Our response time was 24 minutes to clinic. Called in non-emergent. Pt sat for aporx 49 minutes on 2L O2. With 6 out of 10 CP.


The question I have again is, why don't these clinics increase the O2. They put these Pts on NCs and get sats in the mid to upper 90s and just say, they're sating fine.

We don't care how much O2 is in a Pts finger, the HEART NEEDS O2 !!!!!!!

Time and time again, call after call, we go to these clinics, these "Docs in a Box", for people having CP and all they do is put them on a NC at 2L.

I always carry in a NRB with me, when we get dispatched to these clinics, and 98% of the time, I end up putting them on the Pts.

Is there a Medical reason why these MDs do this?