Effects of Hyperoxygenation

[CGFD37]

I'm in the process of writing a paper on the effects of hyperoxygenation in the pre-hospital setting. It's something that bugs me, every patient get 15LPM NRB, regardless thier respiratory condition. Not only do I think it's abusing O2 thearpy, the more I have researched it, the more information there is available on how hyperoxygenating patients can be harmful. If anyone has any information on this subject, that would be most helpful. Thanks guys!

 

[BrandoEMT]

I have no information for you but when you complete your paper I would be interested to have a copy if you wouldn't mind! I'll pass this along to a friend who might have some research in this area.

B

 

[CGFD37]

you bet, i'll let you know!

 

[ResTech]

Off the top of my head I know that hyperoxygenation (if your using that synonymously with hyperventilation) has been shown to be harmful in arrest situations due to increasing intrathoracic pressure causing a decrease in blood return to the heart.... otherwise known as hyperventilation-induced hypotension.

And then you got the classic COPD scenerio which Im sure you know all to well. Itz still amazing how so many providers still give concern to this pre-hospital. Hyperoxygenating these patients is NOT going to cause them to go into arrest in the short amount of time we have these patients in the field.

I am bent on explaining this cause I think it is important for providers to understand and realize the old school teaching is wrong and a myth!(well almost). ------->

COPD patients experiencing an exacerbation of their condition are hypoxic.. and a hypoxic patient is a hypoxic patient. Meaning their need for O2 to correct the hypoxia is EXACTLY the same as a non-COPD patient's need. The DIFFERENCE is the bio-chemical trigger for respiration. Non-COPD patients breathe based on the level of CO2 or more specifically hydrogen whereas COPD'ers breathe based on the level of O2. This is due to the patients receptors for breathing becoming desensitized to high-levels of CO2 (ex. from years of smoking) forcing the body to find a new trigger to breathe which becomes oxygen. This is why we have all been taught that high-flow O2 will cause our patient's to go into respiratory arrest.

The body basicly say's, "hey, Im responding to O2 levels now for my cue to breathe and I am getting alittle to much so Im gonna slow down or stop breathing all together to try and maintain the chemical balance Im supposed to". The brain never got the memo about the new trigger to breathe which is why the process is messed up. Normally, for the O2 and CO2 levels to get out of whack enough for the body to stop breathing, it will take a few days not 30mins.

Hope that helped some that didnt fully understand the whole O2 and COPD patient thing. I agree, it shouldnt be taught to put every pt. on 15lpm everytime. But thatz the result of a lack of teaching A&P in a revised, dumbed down Basic curriculum.

 

[ffemt8978]

I'd be interested in getting a copy of that report also, but I am unable to give you any help on the subject.

 

[MMiz]

Though I don't have the reports, I know several big studies have been done on hyperventilation being harmful. You'll find changes in ACLS / CPR 2005 that reflect this.

Our service is field testing a device that fits on to the BVM/face mask that lights up every time we are to ventilate the patient.

It is my understanding that an EMT working a code will in general give 30+ breaths-per-minute. That's too many.

Device:

 

[JJR512]

I wouldn't assume hyperoxygenation is the same as hyperventilation. Linguistically they don't mean the same thing. Being hyperoxygenated means you're breathing in more oxygen than you need, or is good for you; being hyperventilated means you're being ventilated more frequently than you need, or is good for you. Hyperventilation doesn't necessarily increase the amount of oxygen actually in your bloodstream.

It's possible to be hyperoxygenated while breathing at a normal depth and rate.

Yes, oxygen can be toxic at higher-than-normal concentrations; the effects can vary and depend on the concentration and time of exposure.

It's not a concern to pre-hospital medical providers because oxygen is being administered to people who couldn't breath in enough oxygen on their own. Ideally it should be given only to people who need it (or request it); it's been my experience in training that on the street, oxygen isn't administered nearly as often as it should be according to the book and the teacher.

By the way, another term you may be interested in is hyperoxia. This is the condition in which a person becomes when that person gets hyperoxygenated. (This is just as hypoxia is the condition in which one becomes when one cannot inspire enough oxygen.)

Some symptoms of hyperoxia may include dizziness, nausea, twitching (especially on the face), and eventually convulsions. Lung damage, potentially irreversible, may also occur, as can damage to the retinas.

 

[ResTech]

Thatz a really cool device to indicate when to give ventilation... how much is something like that?

 

[CGFD37]

hey guys, thanks for all the good information. I've been researching the effects of oxygen toxicity, and is going to be the driving force behind the report. also i'm planning on including information on oximeters readings in relation to the oxygenation of our pt's. when i finish the report i'll email it to anyone interested. thanks again guys, and keep the advice comming!

 

[Summit]

I thoguht you wouldnt see CNS O2 toxicity without an ambient ppO2 > 1000mmHg

 

[ResTech]

Ive never heard of adult O2 toxicity producing those symptoms except for like respiratory alkalosis (aka hyperventilation).. the typical paresthesia.. peripheral numbness, tingling, dizzy, etc. Infants is another case but not adults.

 

[fm_emt]

Device:

Or, the "ResQpod" - the manufacturer has some really interesting videos about the product on their website. I watched them the other day.

 

[Jon]

I'm intrested too...

 

[medic03]

the ResQpod costs $90 bucks a shot and has a shelf life of 2 years. pretty interesting stuff, have it here. Only to be used in cardiac arrest.

 

[Jon]

There is also a new product ou that is a $2 timer.... blinkie light flashes 1x every 6 seconds... dosen't have the circulatory effects... but still gives you the blinkie light

 

[MMiz]

The ResQ Pod's primary function isn't to blink, though it's part of the product.

The ResQ Pod is a one-way valve located between the airbag (used to transport air into the lungs of the cardiac arrest patient) and the endotracheal tube placed into the patient's throat and lungs. The valve can also be used with a facemask placed over the patient's nose and mouth or other resuscitation devices. During CPR, the one-way valve creates a small vacuum within the patient's chest, increasing the return flow of blood to the heart. Research has shown that the volume of blood circulated through the body during CPR can be doubled when using both of these devices.

But it blinks too!

 

[Jon]

The point of the timer/ blinkie light is that it gives you the blinkie light if you can't afford the ITD...

"Lyfetymer Metronome" - From Tri-Anim - www.tri-anim.com - Part Number: 496-LT1006