Over Oxygenation in Emergency Medical Services - Research Paper Example

Over oxygenation in Emergency Medical Services Oxygen has been a vital component of providing emergency medical services and other health-related treatment. In fact, oxygen is considered as a drug that can ease complications from hypoxia – a life threatening condition; thus, it is necessary that emergency medical providers have knowledge about oxygen administration and treatment. In addition, a number of researches and studies have identified the usefulness of oxygen in emergency tracheal intubation of adult patients, nausea and vomiting, limb fractures, myocardial ischemia, cardiac arrest, chronic obstructive pulmonary diseases, neonatal resuscitation, stroke, and even in analgesic purposes (Anderson, n.p.). However, just like any other medications, too much of something is bad for the body; the same goes for oxygen. Even if it ease a number of diseases, studies revealed that too much oxygen might lead to a condition known as hyperoxia. Therefore, this paper hypothesized that there is significant harm in over administration of oxygen in patients receiving emergency medical services. To support the hypothesis, a number of studies involving over oxygenation were noted in this paper; among of which include those from the Emergency Medicine Journal. According to this study, several guidelines and prehospital textbooks advocate and emphasize the use of low oxygen therapy in treating patients with chronic obstructive pulmonary diseases (COPD); however, the study found out the reality that ambulance crews are still over oxygenating approximately 80% of COPD patients or those with acute exacerbations (Emergency Medicine Journal, n.p.). The study about COPD and oxygenation is a case-proof that eventhough oxygen is the most therapeutic agent used in the prehospital environment, it could also be the most detrimental prehospital treatment if used in excessive amount. It has also been noted that in patients with COPD, a significant increased in the concentration of carbon dioxide after oxygen therapy has been observed; thus, leading to a conclusion that hypercapnia has developed because of too much oxygenation. We all know that hypercapnia is dangerous to patients with COPD as it will worsen the acute exacerbation felt by the patients, reduce hypoxic respiratory drive, and will eventually lead to increasing severity of respiratory failure. In the review of current research on supplemental oxygen use in the prehospital field, Anderson highligted several studies which pointed out harm in hyperoxia including the insolubility of oxygen in the blood which could explain why there should be a limit in oxygenating a patient (n.p.). In addition, oxygen may also act as a vasoconstrictor in response to the autoregulation of the cardiovascular system due to increasing levels of oxygen saturation. These systemic effects, together with its implications, have been used as guiding theories for emergency medical service provider in giving early interventions to cardiac and respiratory diseases. The Cochrane Review and the American Heart Association, together with the randomized controlled trial conducted by the British American Journal, found a strong indication that oxygen may pose potential harm in patient with uncomplicated myocardial infarction; thus, the body recommended in the 2010 CPR guidelines that supplemental oxygen be no longer administered to patients with uncomplicated cardiac chest pain and oxygen saturation level of more than 94% (Anderson, n.p.). Likewise, another review pointed out that administration of supplemental oxygen to patients with cardiac arrest could be more detrimental due to the increasing mortality of experiencing cardiac arrest. An alarming findings of the review pointed out the same result from the Emergency Medicine Journal. In the review, it has been found that emergency medical services providers often administered high-flow supplemental oxygen in patients with exacerbation of COPD. A relative risk of death has resulted to this action as evidenced by the doubling of mortality (Anderson, n.p.). Similarly, the review has found correlation of supplemental oxygen administration in resuscitation of neonates to retinopathy of prematurity which may eventually lead to blindness and in possible harm of patients suffering acute ischemic stroke. Other harm from supplemental oxygen includes thickening of alveolar membranes, restriction of lung expansion, seizures, free radical damage, and widespread vasoconstriction (Anderson, n.p.). Therefore, it can be gleaned from the review that administration of supplemental oxygen by emergency medical services providers be not a traditional pre-hospital care but more of a drug-based practice. This change in the traditional role of the emergency medical providers have been studied by Joe Hopple in 2011. Hopple observed that providers traditionally administer supplemental oxygen to every patient that they think needs oxygen; however, he stressed out that this traditional belief needs to be modified (n.p.). The challenge could be done easily to new emergency medical providers but not to the old ones who were used to the practice and tend to overlook the challenges in oxygen therapy, one of which is to educate emergency medical providers that supplemental oxygen is also a drug which has indications, contraindications, side effects and dosing requirements. Then, basic information follows such as the rationale for giving oxygen, anatomy of the respiratory system, and body regulation and use of oxygen. With these, the study implied that it is the lack of education which predisposes emergency medical services providers to over oxygenation in their practice. While of the journal articles and reviews stated above focused on the over administration of oxygen, the review made by Weingart and Levitan focused on preoxygenation and peri-intubation techniques to reduce the risk of hypoxemia, particularly techniques in positioning, preoxygenation and denitrogenation, use of positive pressure, and passive apneic oxygenation during emergency tracheal intubation of adult patients (1). Contrary to other reviews, preoxygenation brings patients’ oxygen saturations close to 100%, maximize oxygen storage in the lungs, and denitrogenate and oxygenate bloodstream to achieve safe apnea in every emergency tracheal intubation. Thus, this means that an emergency medical services provider will have to administer a high-flow oxygen during preoxygenation. The review also contradicted other studies’ recommendations that prohibit oxygen administration to patients with adequate respiratory drive and the harm that may result if a high saturation of oxygen is achieved; instead, the review recommended high-flow preoxygenation administration during emergency endotracheal intubation to lower the risk of hypoxia and maintain an adequate amount of oxygen. Meanwhile, a continuing education activity which was approved by the Emergency Medical Services World Magazine (an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services) addressed the essential information and possible complications of oxygen administration that emergency medical services providers need to know. Collopy, Kivlehan, and Snyder agreed that oxygen is the most used prehospital treatment and the most administered but the most abused/neglected drug (n.p.). Emergency medical services providers often forget that just like a typical medical medication, administration of supplemental oxygen has side effects and could cause potential harm if not used correctly. The report also reiterated that it is not only the imbalances between oxygen and carbon dioxide that should corrected but the nitrogen gas as well because majority of the air we breathe is actually nitrogen. In addition, nitrogen is also essential in oxygen administration. If there’s a finding of this report that could be significant, it is the statement that maximum partial pressure of oxygen is neither increased nor affected when supplemental oxygen is applied. The report also enumerated complications of oxygen delivery including skin irritation and breakdown, drying of the mucous membranes, oxygen toxicity, absorbative atelectasis, and carbon dioxide narcosis (Collopy, Kivlehan, and Snyder, n.p.). The complications experienced by the patients during provisions of oxygen are sometimes attributed to the faulty delivery systems (plastic systems, nasal cannulas, oxygen masks) and the nearly zero moisture content. Oxygen toxicity has been in existence since 1900s and has affected patients from all ages. Emergency medical service providers need to equip themselves with the appropriate and up-to-date information about oxygen and medication administration in order to deliver a safe and effective care for patients under respiratory distress. Lastly, a news report from McEvoy questioned the safety of oxygen administration and the lack of reason for giving it and any other types of medication. McEvoy cited studies suggesting hypoxia and hyperoxia are equally dangerous; thus, have resulted to this question of safety (n.p.). He also emphasized the The Guidelines for Emergency Cardiac Care (ECC) in 2000 and 2005 which does not recommend administration of supplemental oxygen for patients with saturations above 90 percent. He supported the findings of the studies and reports which were stated above as there is little to no evidence suggesting any clinical benefit of oxygen saturations above 90 percent in any patient. Therefore, the news report of McEvoy also emphasized and called for appropriate dose and delivery of a drug called ‘oxygen’. Works Cited Anderson, David. "Several Studies Point Out Harm in Hyperoxia." Journal of Emergency Medical Services (2011): n.p. Online. http://www.jems.com/behind-the-mask. Collopy, Kevin T. Kivlehan, Sean and Snyder, Scott R. Oxygen Toxicity. Continuing Education Activity. Wisconsin: Cygnus Business Media, 2012. Online. http://www.emsworld.com/article/10523286/oxygen-toxicity. Emergency Medicine Journal. "Oxygen: kill or cure? Prehospital hyperoxia in the COPD patient." Emergency Medicine Journal (2006): n.p. Online. doi: 10.1136/emj.2005.027458. Hopple, Joe. "EMS Education Overlooks Challenges of Oxygen Therapy." Journal of Emergency Medical Services (2011): n.p. Online. http://www.jems.com/article/training/ems-education-overlooks-challenges-oxyge. McEvoy, Mike. Can oxygen hurt? News. Georgia: EMS1.com, 2012. Online. http://www.ems1.com/columnists/mike-mcevoy/articles/1308955-Can-oxygen-hurt/. Weingart, Scott D. and Levitan, Richard M. "Preoxygenation and Prevention of Desaturation During Emergency Airway Management." Annals of Emergency Medicine, XX(10) (2011): 1-11. Online. doi:10.1016/j.annemergmed.2011.10.002. Read More