Ms. Dyspnea: "I don't like this oxygen mask. It hurts."
Dr. Grumpy: "Well, you need it to breathe. The other only other option would be to intubate you and have a machine do the breathing."
Ms. Dyspnea: "That's what the idiot nurse told me!"
Dr. Grumpy: "It's the truth. You need oxygen to keep going."
Ms. Dyspnea: "Bullshit. I asked the nurse if I could just get the oxygen in my IV, and she said she couldn't do that. We all know she could just take off this stupid mask and plug it into my IV instead."
31 comments:
The patient 9customer in the USA?) is always right. Do it, she won't bother you any more, one fewer idiot for the gene pool.
Tempting though it may be...
She needs that oxygen more than she realizes...
Nice
ECMO! ECMO! ECMO! I know a few cardiovascular surgeons you could consult that would gladly put in ECMO based solely on that conversation.
A little less dyspnea, a little more apnea?
Don't give her IV oxygen and you get a bad patient satisfaction score.
Give it and she won't be around to fill out the survey, but a lawyer will be involved.
You can't win.
You gave this Respiratory Therapist a good laugh this morning. Thank you!
Do it do it do it do it do it do it do it do it
Every ICU nurses' nightmare!! Or that a family member will do it...
That one is choice.
Sounds like there's already been some significant oxygen deprivation.
"In the event of a loss of cabin pressure, an IV tube will drop down from the overhead compartment. Be sure to fix the needle in your own vein before assisting others."
OK, I'll do it but you'll only be able to tolerate about 1-2 cc at a time.
How old is she ? Over 75, no oxygen. We have 7.4 billion persons on this earth we need to start cutting back, seriously .There is only so much oxygen to go around.
The poor dear. But, don't try to humor her.
I can't help but think of this Simpson's reference https://youtu.be/2i3zrzyLOCw.
Maybe add a dementia workup - evidence of impaired judgement, critical thinking.....oh no, wait - she's an American voter who watches only Fox news. That's the etiology of the problem.
And no, you can't give her what she wants....you paternalistic doctor who just wants to torture her so you can make money!
It's either laugh or cry, with this one. Thanks for sharing, Dr. Grumpy.
Hang a bag of 3% hydrogen peroxide - that's one way to deliver oxygen intravenously (I didn't say it was delivered harmlessly now, did I?).
Those three little dangerous words: "We all know..."
It is available, but thus far only in very small trials:
Sci Transl Med. 2012 Jun 27;4(140):140ra88. doi: 10.1126/scitranslmed.3003679.
Oxygen gas-filled microparticles provide intravenous oxygen delivery.
Kheir JN1, Scharp LA, Borden MA, Swanson EJ, Loxley A, Reese JH, Black KJ, Velazquez LA, Thomson LM, Walsh BK, Mullen KE, Graham DA, Lawlor MW, Brugnara C, Bell DC, McGowan FX Jr.
Author information
Abstract
We have developed an injectable foam suspension containing self-assembling, lipid-based microparticles encapsulating a core of pure oxygen gas for intravenous injection. Prototype suspensions were manufactured to contain between 50 and 90 ml of oxygen gas per deciliter of suspension. Particle size was polydisperse, with a mean particle diameter between 2 and 4 μm. When mixed with human blood ex vivo, oxygen transfer from 70 volume % microparticles was complete within 4 s. When the microparticles were infused by intravenous injection into hypoxemic rabbits, arterial saturations increased within seconds to near-normal levels; this was followed by a decrease in oxygen tensions after stopping the infusions. The particles were also infused into rabbits undergoing 15 min of complete tracheal occlusion. Oxygen microparticles significantly decreased the degree of hypoxemia in these rabbits, and the incidence of cardiac arrest and organ injury was reduced compared to controls. The ability to administer oxygen and other gases directly to the bloodstream may represent a technique for short-term rescue of profoundly hypoxemic patients, to selectively augment oxygen delivery to at-risk organs, or for novel diagnostic techniques. Furthermore, the ability to titrate gas infusions rapidly may minimize oxygen-related toxicity.
Comment in
Boosting oxygenation during acute respiratory failure. [Sci Transl Med. 2012]
-End Quote
So far as I know, only tested in ED use.
If she is on CPAP/BiPap, I have some sympathy for her. That is not comfortable.
I'm gonna venture to guess this patient is likely a wee bit past the point where she'll be contributing to the "gene pool."
Agreed (last 2 sentences). I don't know anything about the product you're describing because I'm not in that field.
For a lighthearted humor blog,in surprised sometimes by the amount of spite and lack of compassion in some of the responses.
I am surprised the CPAP people haven't come up with a hospital product similar to 'air pillows', to provide more comfort than those little plastic pronged delivery apertures. When my father was suffering in the last few months of his life from pulmonary fibrosis due to chronic exposure to methotrexate for his rheumatoid arthritis which he willingly chose up-front so he could participate in his grown children's and grandchildren's athletic adventures (mountain climbing, Dall sheep photography, alpine skiing, spelunking, etc.--even, when he was infirm he would take his portable oxygen on the Disability Van to the YMCA natatorium) he would complain about the oxygenation apparatus. Exposure to constant air in a nose dries nares with taut inner skin. You'd think with all the technology that goes into producing the life-saving gas, that 'they' would come up a product that promotes 'adherence'.
Trump says....You shouldn't pick on me that way, you are being totally unfair. Oxygen in the IV is done all the time. I know cause I am very, very smart. In fact I am one of the smartest people of all time and probably have the best temperaments as well so just put the stuff in my vains (hehe) and let me do my job.
The nurses love me. I'm doing great with the nurses, especially the Muslim ones and my African American one. I think the Mexican one even agreed to put the O2 in my IV even though the little doctor wouldn't order it.
Besides Putin does it all the time. We gotta be smart and tough. Not weak.
She is way ahead of you all and I suggest each of you Google Intevenous oxygen delivery.
For short term emergency intervention. Do you have a link to it being used otherwise?
I'd be surprised if Grumpy didn't know about it. But I'll keep an open mind if you have a reputable link.
See Glen's post above or Google it for yourself.
I did Google it and reported the results in my post above.
Glen's post references a paper about administering iv O2 formulation to rabbits. My understanding is that Grumpy ' s patient is a human.
You have assumed too much.
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