# Contraindications to O2 Administration



## MMiz (Feb 25, 2007)

As a trained lay rescuer, are there any contraindications to emergency O2 administration to the general public?  I can't think of any.

Thanks!


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## Ridryder911 (Feb 25, 2007)

Yes, it is a prescribed medication and to do without meeting the requirements for having or need to the use of oxygen is not following what you were taught, but I am sure your protocols specifically describes when and how to use oxygen, when you are deviating from them you are in violation. To distribute  any medication (including oxygen) without orders (protocols) is practicing medicine without a license.  That is why "oxygen bars" only can administer room air (21%) scented oxygen. 

Second question is why would anyone want to ?

R/r 911


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## MMiz (Feb 25, 2007)

ridryder 911 said:


> Yes, it is a prescribed medication and to do without meeting the requirements for having or need to the use of oxygen is not following what you were taught, but I am sure your protocols specifically describes when and how to use oxygen, when you are deviating from them you are in violation. To distribute  any medication (including oxygen) without orders (protocols) is practicing medicine without a license.  That is why "oxygen bars" only can administer room air (21%) scented oxygen.
> 
> Second question is why would anyone want to ?
> 
> R/r 911


Rid.

Tell me how you really feel .

First, it would not be part of the standard school response, but would be administered by our on-site LPN or EMT.

Second, because we are not an EMS agency, we created our own guidelines based on a template (and being approved by EMS director and MD).  We're waiting on the MD's RX, but the local EMS service actually was all for it.

I grew up in schools that had O2, and the O2 was used on numerous occasions.  I can only remember it being used at large gatherings (in hot gyms) where someone passed out or was feeling dizzy.  I can remember my principal using it during the student vs. staff basketball game my senior year.  I just see it as another tool.

I can't find a single concrete contraindication for O2.  By the time the COPD patient suffers we'll be out of O2.  Use on infants and newborns is addressed.

My question is, do you think this would be detrimental to our emergency response plan?  There is a fine line between a good plan and whackerdom.  I don't want to cross that line.

Our school would love to advertise that we have one of the most progressive response plans/teams in the nation.  I'd like to help them do that.


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## VentMedic (Feb 25, 2007)

There are exceptions to every rule. Trained First Responders can administer O2 until EMS arrives. 

Dive boats, Industrial sites, various school and athletic programs have trained "Oxygen Providers".

http://www.franklincountyva.org/pub_safety/EMS/Protocols/o2_admin_schools.htm


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## Ridryder911 (Feb 25, 2007)

Although, personally I agree with there are probably no dangers in administration, many out there do not understand it is still considered a drug.. and hence if there was any questions, I would have a medical control to at least write a letter for orders of such for liability purposes. 

R/r 911


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## ReebTop (Feb 25, 2007)

Wouldn't the administration of oxygen in a situation where the administering person acted in good faith in an attempt to help be protected by Good Samaritan laws or whatever local analogue may exist?


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## VentMedic (Feb 25, 2007)

ridryder 911, Agreed.

Most States already have rules in place. It is then up to the local schools to follow this rules as guidelines to create their own policy that benefits that particular school. 

Believe me, it took some serious lobbying to get inhalers/epi-pens back into the hands of children that rely on them instead of waiting to the school nurse miles away or EMS to get to the child on the football field. Time is brain cells.

The same for dive boats.... 

Like the AED, the O2 should have a special place and be used by trained people only. It doesn't require a lot of training for oxygen. Look at the number of people in home care that rely on their loved ones to assist. I have about 15 minutes to teach them everything they need to know and walk away, hoping for the best. That is, after I get them to put down the cigarettes. 

So yes, I feel very comfortable teaching teachers, students, and secretaries in a school system to administer oxygen in an emergency if their State allows. Education is the key. 

examples:

http://www.dshs.state.tx.us/schoolhealth/pgtoc.shtm

http://www.nmschoolhealthmanual.org/shm_07.pdf

http://www.healthinschools.org/ejournal/2003/sept1.htm

Florida O2 for emergency use only
http://www.doh.state.fl.us/pharmacy/info-CompressedMedicalGas.html


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## Chimpie (Feb 25, 2007)

ReebTop said:


> Wouldn't the administration of oxygen in a situation where the administering person acted in good faith in an attempt to help be protected by Good Samaritan laws or whatever local analogue may exist?


Maybe if it was just John Q Citizen using it, but Matt is an EMT, and is the one overseeing the program (my guess).  That alone would probably throw the Good Samaritan act out the window.


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## TKO (Feb 25, 2007)

There's really just two parts to Oxygen administration: 
1) knowing HOW to use it, and
2) knowing WHEN to use it.

We don't give O2 to everyone just because we can.  And a nasal canula is going to be beneficial to everyone because it only increases sats slightly.  But if they are walking wounded, like a sprained ankle, I wouldn't bother.  If sats are 98% and no pain complaints then I would likely withhold it too (depending on the C/C).

As for contraindications, some people don't like O2 (seen it) and flow rate will be a concern for pts with COPD (unless they are in resp. distress).  Too low of a flow rate for pts that need higher could be considered a contraindication as well, ie: pt that has sats of 99% that was exposed to CO.


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## LIFEGUARDAVIDAS (Feb 25, 2007)

There are some basic courses for O2 providers. For example, many diving organizations which use similar training systems to the original one from PADI. 

Between the Advanced Open Water Diver and the Rescue Diver certification levels, the student has to take the EFR (Emergency First Response). This course is from DAN which also offers BLS, O2 administration, etc. All of them are designed for people who are not in any medical emergencies related profession. 

Since I had AHA BLS, ARC "CPRO" & NAEMT PHTLS before starting the rescue diver course I wasn't required to take the EFR. Though I can't tell you how those courses really are, for what I've seen they meet their purpose. Both PADI and DAN certifications are recognized world-wide, so the O2 provider course surely meets any Oxygen-administration-related law in the US.

Another option, a bit more advanced is a First Responder course available at some paramedic schools. Usually they meet the USDOT curriculum.

Both options meet the main two parts of Oxygen administration (as TKO said), "1) knowing HOW to use it, and 2) knowing WHEN to use it." 

Good luck,

Guri


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## VentMedic (Feb 25, 2007)

If we're still talking O2 delivery for schools; there are relatively no contraindications for kids in emergency situations. (unless it is a neonate with uncorrected ductal dependent lesion in the heart) Kids are not small adults and have a different O2 consumption level. They may actually benefit from O2 without worrying about high SpO2. What you see on the pulse ox may not be what the tissues are seeing.  Bacterial Meningitis is one disease that mimics the flu but wreaks havoc in a very short period of time. Tissure death starts almost immediately. 

If kids need EMS at schools; soft tissue and bone injuries...other than that, if they are sick enough for EMS.... don't split hairs on O2 delivery. Kids can decompensate quickly.

Teachers and school staff should already be familiar with O2 with the increasing number of medical needs children now in our school system. If they are not familiar; time to get familiar. We're saving 22 weeks preemies now. They'll be in the school systems soon enough. This is the future.

http://www.medscape.com/viewarticle/425117


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## TKO (Mar 1, 2007)

Kids are the only standing case where a cap refill exam is still effective.


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## Guardian (Mar 1, 2007)

MMiz said:


> Rid.
> 
> Tell me how you really feel .
> 
> ...





my gut says you stick with teaching and let me handle ems.  Anotherwords, pick a profession.  My gut could be way off on this as I admittedly don't have any experience with this kind of thing.  Is O2 really that critical or can't you just wait for ems to show up.  First aid, yea, know how to put a band aid on and of course know CPR.  Anything beyond that, I don't see the point, unless you're hoping to be sued.


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## Guardian (Mar 1, 2007)

ridryder 911 said:


> Yes, it is a prescribed medication and to do without meeting the requirements for having or need to the use of oxygen is not following what you were taught, but I am sure your protocols specifically describes when and how to use oxygen, when you are deviating from them you are in violation. To distribute  any medication (including oxygen) without orders (protocols) is practicing medicine without a license.  That is why "oxygen bars" only can administer room air (21%) scented oxygen.
> 
> Second question is why would anyone want to ?
> 
> R/r 911



So o2 bars are really just air bars, what a crock, not that it would do anything at 100% but still.


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## VentMedic (Mar 1, 2007)

To think "EMS" providers are the only ones that can do O2 is arrogant at best.

For 25 years many States have been working on educating the educators on emergency procedures. Most States have established guidelines for the school system to work with. In my previous posts I gave links to such examples. We tell the people to go for a NRBM if not vomiting, NC if vomiting...Period. 

And yes, oxygen is very important especially in children who have no reserve and have different O2 consumption requirements.

TRAINED first responders of any type; parents, teachers, secretaries, etc can safely administer some type of assistance, esp O2, until help arrives. AED training is also a must.  We are lobbying for ALL teacher programs to include first aide and first responder training. 

Athletic trainers and coaches (degreed) do have first responder trainer and beyond. If they have an exercise science degree...they are well advanced. Many teachers also have what many EMTs and Medics do not have; science (A&P) classes AND an understanding of children.

Probably the biggest advantage of having an educator participate in a first response program is comfort to the child having a familiar face there. Face it, alot of EMTs and Medics are not comfortable with children and it shows. The child can sense it. 

There are too many children in our school systems who have some type of medical needs; asthma, diabetes, cardiac, BPD, too name a few. Gambling on that child's "quality of life" for the future.....

The sad thing is a lot of EMTs and Medics are never able to follow up on a child they bring into the hospital. If they get there with a heart beat...it's a save. In the hospital, if you ask later, all we can tell you is alive and stabe. We can not tell you for privacy reasons about the trach, peg and future at a pedi nursing home. You can also tell by the growning numbers of pedi nursing homes that there needs a change toward more education in all systems.

Sorry for the soapbox...lost a child in 1980 on a call to a school. The child's inhaler was locked up in a nurse's ofc who was "at lunch".  I became a Respiratory Therapist later to be able to do more for kids. I have trained teachers and parents to administer whatever it takes to save the child (within the guidelines of State statutes).

So, check your State's guidelines and run with it to the fullest to provide the fastest and effective initial care.


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## Airwaygoddess (Mar 1, 2007)

Very well said and a great post!!


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## Guardian (Mar 26, 2007)

I didn't read it until now but yes, good post vent.


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## Stewart1990 (Jul 27, 2009)

The only thing I can think of as a contraindication for O2 would be hypoxic drive. BTW, we are taught that everyone gets oxygen. If you don't put O2 on a patient, you fail. Its applied immediatly after c/c and the only exception is non-emerg. transports ( just what were taught, I'm not trying to set guidelines here)


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## HNcorpsman (Jul 27, 2009)

contraindications- COPD


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## Stewart1990 (Jul 27, 2009)

HNcorpsman said:


> contraindications- COPD



Very true- all you can really do is keep them in position of comfort, suction if neccesary......and maybe CPAP'em if the begin to decompensate


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## HotelCo (Jul 27, 2009)

HNcorpsman said:


> contraindications- COPD



You shouldn't withhold it if they need it though. You need to use your judegment.


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## VentMedic (Jul 27, 2009)

HNcorpsman said:


> contraindications- COPD


 
I see you are very new and have a lot of reading to catch up on.


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## HNcorpsman (Jul 27, 2009)

sorry, its always been taught to me that that was a contraindication.


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## VentMedic (Jul 27, 2009)

HNcorpsman said:


> sorry, its always been taught to me that that was a contraindication.


 
Start reading.  You'll find my posts as well as a few others that contributed to the many threads on the topic.  The links will give you plenty of information.   Remember, hypoxia will kill quicker than hypercarbia.


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## Explorer127 (Jul 27, 2009)

Why shouldn't you give people with COPD O2?


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## Sasha (Jul 27, 2009)

Explorer127 said:


> Why shouldn't you give people with COPD O2?



My understanding is that people believe that COPDers have a hypoxic drive and are stimulated to breathe by low O2 levels and not high carbon dioxide levels like "normal people" because they normally have high CO2 levels in their blood, and that by giving them too much O2 you will decrease their respiratory rate. But I also understand a very small percentage of patients have a hypoxic drive, and even so you shouldn't withhold oxygen.


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## Explorer127 (Jul 27, 2009)

Sasha said:


> My understanding is that people believe that COPDers have a hypoxic drive and are stimulated to breathe by low O2 levels and not high carbon dioxide levels like "normal people" because they normally have high CO2 levels in their blood, and that by giving them too much O2 you will decrease their respiratory rate. But I also understand a very small percentage of patients have a hypoxic drive, and even so you shouldn't withhold oxygen.



Interesting. I'm assuming you would still give them the O2 if they had a really low O2 sat, correct?


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## Sasha (Jul 27, 2009)

Explorer127 said:


> Interesting. I'm assuming you would still give them the O2 if they had a really low O2 sat, correct?



If your patient says they are SOB, or look like they're having trouble breathing, are cyanotic, etc. Give them O2. Don't depend on a pulse ox to tell you when to give oxygen and when not to.


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## MSDeltaFlt (Jul 27, 2009)

MMiz said:


> As a trained lay rescuer, are there any contraindications to emergency O2 administration to the general public? I can't think of any.
> 
> Thanks!


 
Sorry for the late post here guys.  But, according to what I know about O2 admin, there are only 2 contraindications to admin of emergent O2 in the prehospital setting.

1.  Those who are not patients and are not complaining of anything whatsoever.

2.  Those who have been discharged to the morgue.


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## reaper (Jul 27, 2009)

Wait, you don't give O2 to the #2 pt's. Dang that is why the ME keeps looking at us funny!


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## Shishkabob (Jul 27, 2009)

COPD isn't a contraindication to O2.  You just have to use your brain.


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## ResTech (Jul 28, 2009)

There are no actual contraindications of O2 use pre-hospital. However, there is mounting research that is rethinking the old adage of "O2 never hurt anyone". The AHA even recommended that patients not be blanket treated with 100% O2 due to evidence showing some potential harm from free radicals. 

Treat the patient and administer O2 contingent upon their actual needs.


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## MendoEMT (Jul 28, 2009)

Just so long as you advise your pt not to smoke while on O2!!  Seriously, had a guy a couple of months ago who nearly burned his face off because he was smoking with his cannula on!! What a gomer!!


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## Brandon O (Jul 28, 2009)

Can anyone smarter than me (or at least anyone from fire -- not that those are mutually exclusive  ) advise as to the actual "flammability" of 100% O2? My understanding was always that oxygen is not really flammable, per se, in the sense that it will ignite on its own; it's simply an accelerant for any flame which already exists. But then the story about the COPDer with the cannula and cigarette is a perennial favorite so I don't really know.


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## ResTech (Jul 28, 2009)

Fire needs three things to burn... Heat, Fuel, and Oxygen. Oxygen is an oxidizer and makes combustion much easier to occur. Think of it as super sensitizing the reaction.


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## reaper (Jul 28, 2009)

All the oO2 will do to a cigarette is make it burn faster. The danger comes from lighting it. It can turn a 1" flame into a 1 foot flame!


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## VentMedic (Jul 28, 2009)

Brandon Oto said:


> But then the story about the COPDer with the cannula and cigarette is a perennial favorite so I don't really know.


 

Since you are from California, you would have heard the TRUE stories of the many deaths that have occured in that state related to smoking and oxygen.  

When a person know what happens when they light a cigarette while wearing O2 they will often remove the cannula and lay it in bed with them.  Thus, when they accidentally drop the cigarette into the bed clothes, it goes into an oxygen enriched environment.   

It is very difficult to weigh the odds of safety when a person is still smoking but requires home O2.  The surviving family members love to hold the physician and other  healthcare professionals responsible when a patient is sent home on O2 and then perishes in a house fire.

There is also another important issue to consider with patients who are smokers when it comes to giving O2.  Many of you may have been taught a SpO2 of 92% is fine for "COPD" patients.  However, if they are still smoking their actual SaO2 could be 82% and the rest is COHb.  You may have to ignor your recipe and titrate the O2 until some relief is obtain as the SpO2 number will not be a true reflection of the actual "sat".


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## Shishkabob (Jul 28, 2009)

Brandon Oto said:


> Can anyone smarter than me (or at least anyone from fire -- not that those are mutually exclusive  ) advise as to the actual "flammability" of 100% O2? My understanding was always that oxygen is not really flammable, per se, in the sense that it will ignite on its own; it's simply an accelerant for any flame which already exists. But then the story about the COPDer with the cannula and cigarette is a perennial favorite so I don't really know.



O2 isn't flammable.  O2 is combustible.


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## medic417 (Jul 28, 2009)

ResTech said:


> Fire needs three things to burn... Heat, Fuel, and Oxygen. Oxygen is an oxidizer and makes combustion much easier to occur. Think of it as super sensitizing the reaction.



Is it now a tire tetrahedron rather than a triangle in fire science?  Seems like it takes 4 things not 3.  :unsure:


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## Brandon O (Jul 28, 2009)

Linuss said:


> O2 isn't flammable.  O2 is combustible.



What's the difference?


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## firecoins (Jul 28, 2009)

Brandon Oto said:


> What's the difference?



oh boy.  Combustable is go boom.  Flammable is fueling fire so the fire grows, explosion not needed.


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## ResTech (Jul 28, 2009)

Oxygen itself will not ignite because it is not flammable (we established that)... it is combustible.

A flammable gas on the other hand will obviously ignite because it is flammable given the chemical composition of the gas... it only needs oxygen and something to ignite it (ie heat source). 

Oxygen is what allows things to burn. The greater the concentration of oxygen, the much cleaner the burn and much easier it will be for the reaction to occur. 

Basically, with increased O2 concentrations, the reaction is sped up and doesnt have to try as hard to go boom.


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## MSDeltaFlt (Jul 28, 2009)

Brandon Oto said:


> Can anyone smarter than me (or at least anyone from fire -- not that those are mutually exclusive  ) advise as to the actual "flammability" of 100% O2? My understanding was always that oxygen is not really flammable, per se, in the sense that it will ignite on its own; it's simply an accelerant for any flame which already exists. But then the story about the COPDer with the cannula and cigarette is a perennial favorite so I don't really know.


 


Linuss said:


> O2 isn't flammable. O2 is combustible.


 
The internet is a great thing.  Whoever invented Google should be earmarked for sainthood.

http://wiki.answers.com/Q/Does_oxygen_burn


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## MSDeltaFlt (Jul 28, 2009)

ResTech said:


> Oxygen itself will not ignite because it is not flammable (we established that)... *it is combustible*.
> 
> A flammable gas on the other hand will obviously ignite because it is flammable given the chemical composition of the gas... it only needs oxygen and something to ignite it (ie heat source).
> 
> ...


 
No it is not.  Again, I love the internet.

http://wiki.answers.com/Q/Is_oxygen_combustible


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## VentMedic (Jul 28, 2009)

Okay, let's get away from the wiki webs and go with the MSDS sheet which should also be available to everyone working in EMS.

http://www.airgas.com/documents/pdf/001043.pdf

http://www.madamedical.com/pdf/MSDS_Oxygen.pdf


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## MSDeltaFlt (Jul 28, 2009)

Hehehe. Sorry Vent.  My bad.


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## Scott33 (Jul 28, 2009)

Paraquat poisoning is a relative contraindication for supplemental O2 administration.


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## ResTech (Jul 28, 2009)

My bad... I made a mistake... oxygen is an oxidizer that aids in combustion.


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## Shishkabob (Jul 28, 2009)

Brandon Oto said:


> What's the difference?





If O2 was flammable, the earth would be a big fireball right now.


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## Brandon O (Jul 28, 2009)

Fair enough, thanks guys.


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## got_shoes (Jul 29, 2009)

Currently the only true contraindication for O2 administration is paraquat poisioning, but this depends on the amount ingested or obsorbed by your pt. It also depends on how your pt. is presenting if said pt. is hypoxic then you would bag them on room air.


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## AnthonyM83 (Jul 29, 2009)

Do you have any sources on this?
It's a topic I've been trying to study for awhile.


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## reaper (Jul 29, 2009)

Paraquat poisoning is rare, you may never see a case in your career. O2 is contradicted in mild poisoning. If the pt presents with SOB or severe hypoxia, then you provide O2 as normal. For mild SOB, you try to use low flow O2 and keep spo2 levels around 88-92%. In a severe poisoning case, death is almost guaranteed. So treat the pt as palliative care and assist them anyway you can.

I have seen one case in 20 years. That was in the orange groves in FL and it was being used illegally. You may come across it more as a suicide attempt. 

So, never withhold O2 from a pt in respiratory distress.


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## nomofica (Aug 5, 2009)

Linuss said:


> If O2 was flammable, the earth would be a big fireball right now.



maybe that's what 2012 is all about
earth fall down go boom


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## JB42 (Aug 6, 2009)

nomofica said:


> maybe that's what 2012 is all about
> earth fall down go boom



Medic 1 respond to 3 Milky Way Drive, the Earth residence, for an approximately 4.55 billion year old rock, fallen, requires lift assist. Your call will be between Venus and Mars. Time of your tone, December 21st, 2012 0001 hrs.


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## KillTank (Aug 9, 2009)

ReebTop said:


> Wouldn't the administration of oxygen in a situation where the administering person acted in good faith in an attempt to help be protected by Good Samaritan laws or whatever local analogue may exist?



Like jamming asprin down a strangers throat because they had chest pain...None the less O2 is a drug.


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## usafmedic45 (Aug 11, 2009)

> You may come across it more as a suicide attempt.



That is the only circumstance I've ever encountered it in, and that was not even in the US.  



> Do you have any sources on this?  It's a topic I've been trying to study for awhile.



If you do a Pubmed search you should have no problem finding several reference on it, including a good discussion of a case in _Pediatric Emergency Care_ circa 2006.


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