# Oxygen bottles



## daedalus (Nov 22, 2008)

Lets say you are a rual department based at about 2,000 ft above sea level as your elevation. You have a call to a motorist on a mountain road in your response area, the scene is located at 8,000 ft. What are the effects, if any, on O2, the air inside BVM masks, sterile saline bottles, med vials, etc?


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## Code 3 (Nov 22, 2008)

daedalus said:


> Lets say you are a rual department based at about 2,000 ft above sea level as your elevation. You have a call to a motorist on a mountain road in your response area, the scene is located at 8,000 ft. What are the effects, if any, on O2, the air inside BVM masks, sterile saline bottles, med vials, etc?



In terms of bottles (plastic, glass, etc.):

_Packages sealed at or near sea level will experience an increased pressure differential on the seal/closure/finish with exposure to higher elevations. *This pressure differential can cause leaks.*_

http://www.healthcare-packaging.com/archives/2006/03/leak_testing_liquid_pharmaceut.


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## mycrofft (Nov 22, 2008)

*Happens all the time with aircraft, helos and small planes not always pressurized.*

Plastic wrap tends to poof up a little. Multiple dose vials may act differently but won't rupture.  Only 8k... the biggest effect is that your pt has had less O2 pressure than at lower elevations, until you raise the overall percentage. Vent and Rid can give you better math on that. I might wonder about the balloon inflatable obturators on airways? (Indwelling urinary cath should not pose a prob since it's inflated with saline, water based liquids don't expand or contract). O2 cylinder....no problem. (What about pts with pulmonary blebs, going to get more spontaneous pneumos?).

I'm told that _descending_ can cause airsplints and other inflatables to expand.


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## Tincanfireman (Nov 22, 2008)

Boyles Law addresses this question thusly: Under a constant temperature, gas will compress as pressure is applied. The volume of a fixed amount of gas is inversely proportional to the total amount of pressure applied. If the pressure doubles, the volume shrinks to half. 
An amount of air at higher altitudes is less compressed and therefore takes up more volume than air at sea level. A balloon inflated and tied off at sea level will expand as it rises in the atmosphere.

I have no idea how I remembered Boyles Law from Intermediate class, but there you go. I guess all the Mountain Dew I consumed kept at least one brain cell awake...lol

Here's a chart of differential pressure based on altitude:

Altitude Pressure Altitude Pressure 

0,000 29.92 20,000 13.75
1,000 28.86 25,000 11.10
2,000 27.82 30,000 8.886 
3,000 26.82 35.000 7.041
4,000 25.84 40,000 5.538
5,000 24.89 45,000 4.355 
10,000 20.58 50,000 3.425
15,000 16.88 60,000 2.118
18,000 * 14.94 100,000 0.329

* Almost precisely 1/2 Sea Level

P.S Sorry all the numbers scrunched together...


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## mycrofft (Nov 23, 2008)

*RAPID climbs to greater altitude get more exotic.*

In DESERT STORM a few aviators had teeth start throbbing and reportdly crack or loosen a filling due to crummy dental work and rapid loss of pressure (barodontalgia=dental pain due to changes in air pressure). Ditto joint pain. 
One container affected by that sort of altitude change is the beer can. Open one and drink it ,and it will pack more wallop than you are used to.


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## daedalus (Nov 29, 2008)

Freezing temperatures. At our hypothetical rural station, over night temp frequently dives below 10 degrees F. Sterile water for irrigation would freeze would it not? IV Saline may stay liquid because of the salt content, but one could not infuse cold saline into someone's circulation. Sensitive drugs could be stored at these temperatures? 

Southern California: Temperatures frequently rise to over 100 F in the summer months. Can medications be stored inside a sweltering ambulance?


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## mycrofft (Nov 29, 2008)

*As I've been given to understand..*

Don't use freezing cold NS. Even if it didn't freeze, if it were below 0 deg. Centigrade it could freeze other stuff, like your pt. Some meds might start to precipitate, ask a pharmacist, they love being treated like professionals instead of vicodin dispensers.

I've used units sitting overnight in sub-zero; we had frozen condensation in the unit's built in O2 lines, battery operated stuff was sluggish, and a naugahyde (vinyl) seat cover cracked when pushed on as I was climbing in. Tape adhesive doesn't want to work. Blankets were cold even after the air in the unit had warmed up. BVM's did not want to conform.

High storage temps for shelf items, generally eighty deg F is the threshold, and I believe it shortens shelflife to keep them anywhere near that hot. A car in direct sun can get to 130 deg F.  Tape adhesive becomes problematic. Long enough, and paper wrappers on sterile dressings get brittle. Latex can get brown and brittle in time, including valve flaps on masks, gloves.
Had enough?


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## daedalus (Nov 29, 2008)

mycrofft said:


> Don't use freezing cold NS. Even if it didn't freeze, if it were below 0 deg. Centigrade it could freeze other stuff, like your pt. Some meds might start to precipitate, ask a pharmacist, they love being treated like professionals instead of vicodin dispensers.
> 
> I've used units sitting overnight in sub-zero; we had frozen condensation in the unit's built in O2 lines, battery operated stuff was sluggish, and a naugahyde (vinyl) seat cover cracked when pushed on as I was climbing in. Tape adhesive doesn't want to work. Blankets were cold even after the air in the unit had warmed up. BVM's did not want to conform.
> 
> ...



Thanks for the replies mycrofft. I am trying to bring these issues to our attention, because they concern me. Anyone live in these conditions? how does your agency cope?

At my agency, the ALS units are instructed to remove the pelican box (meds) and bring it into the station when not on calls to protect the meds from high temperatures. This of course can be dangerous if the paramedic forgets the box when being dispatched to a call.


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## Tincanfireman (Nov 29, 2008)

As my agency moves to newer units, we have been instructed to make sure the units stay plugged up when at the station, enabling the A/C to cool the unit via a 30A shoreline. When away from the station, we leave 'em running at the ER, with one of the reasons being to keep the A/C operational. The same is true in the winter; even down here in the sunny South, it does get cold at night. If you search, there is a thread from last year regarding the downfalls of using excessively cooled/heated fluids and the possible effects on the patient.  (I also think any additional posts concerning this should be in a new thread, since the OP referred to Oxygen Bottles.  Just my .02, and the Wonderous Moderator's thoughts shall prevail...lol)


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