# Type of poisoning where giving O2 is instanty fatal



## tickle me doe face (Aug 10, 2011)

I would like to preface by saying yes, this was an extra credit question posed to my EMT class.

EMT class is over though, and I forgot to seek out an answer.

Our instructor told us anyone who could write on the back of their final "one type of poisoning where administering o2 would prove instantly fatal" would recieve "some" bonus points on the exam.

I spent a ton of time researching this question, and could never find an answer that I thought really fit.

On the back of my exam I wrote COPD though I don't know if i got the points to not:unsure:

any ideas anyone?


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## tickle me doe face (Aug 10, 2011)

I realize COPD is not a type of poisoning, but it was the best condition I could come up with.

:blush:


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## abckidsmom (Aug 10, 2011)

http://www.inchem.org/documents/pims/chemical/pim399.htm#SubSectionTitle:9.1.2  Inhalation


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## tickle me doe face (Aug 10, 2011)

abckidsmom said:


> http://www.inchem.org/documents/pims/chemical/pim399.htm#SubSectionTitle:9.1.2  Inhalation



ughh are you kidding? 

I saw that in my research, but decided that it couldn't be right because the instructor stressed that it would be instantly fatal.

I asked him to clarify on what he meant by instant, and he said that in this case, administering high flow oxygen would surely kill the patient by the time we arrive at the hospital.

which sounds crazy for high flow o2 to kill anyone, because we were told everybody get's high flow O2.


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## tickle me doe face (Aug 10, 2011)

also I remember reading that paraquat is an organo-pesticide that was used primarily in mexico, to kill marijuana plants in the 1970's, which i thought added to my guess that paraquat was not the answer he was seeking.


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## JPINFV (Aug 10, 2011)

tickle me doe face said:


> which sounds crazy for high flow o2 to kill anyone, because we were told everybody get's high flow O2.



They're so sweet when they're so young and naive. 

Look up radical oxygen species and reperfusion injury. The unfortunate thing is that from an EMS standpoint, he's "correct." From a medical and biological standpoint, he's wrong. As a quick for instance, how are you feeling right now on room air?


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## Cup of Joe (Aug 10, 2011)

My response would have been this:

At a BLS level, we are not instructed, nor directed by protocols, to withhold oxygen from a patient.  

Yes, I know, it may not be good for the patient, but it's what were told to do.


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## tickle me doe face (Aug 10, 2011)

JPINFV said:


> They're so sweet when they're so young and naive.
> 
> Look up radical oxygen species and reperfusion injury. The unfortunate thing is that from an EMS standpoint, he's "correct." From a medical and biological standpoint, he's wrong. As a quick for instance, how are you feeling right now on room air?



the way we were taught is that molecular oxygen is a radical inhibitor, so it inhibits potentially damaging radical processes within our bodies.


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## JPINFV (Aug 10, 2011)

jcalNYC said:


> My response would have been this:
> 
> At a BLS level, we are not instructed, nor directed by protocols, to withhold oxygen from a patient.
> 
> Yes, I know, it may not be good for the patient, but it's what were told to do.



Just curious...

1. By "withholding oxygen" do you mean to put a patient in an environment devoid of oxygen? 

2. Can you withhold an intervention that was never indicated in the first place? Is spinal immobilization being withheld from medical patients or is it simply not indicated? Are you withholding oral glucose from a patient with leg pain because you don't think (or they aren't if you can measure their blood glucose level) they are hypoglycemic? 

2. Are your protocols online, and if so, do you have a link to them that says the indication for supplemental oxygen administration is "ambulance?"


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## JPINFV (Aug 10, 2011)

tickle me doe face said:


> the way we were taught is that molecular oxygen is a radical inhibitor, so it inhibits potentially damaging radical processes within our bodies.



Demand your money back because your instructor(s) have obviously never heard of "science."


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## tickle me doe face (Aug 10, 2011)

what's wrong with that statement?


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## Shishkabob (Aug 10, 2011)

JPINFV said:


> 1. By "withholding oxygen" do you mean to put a patient in an environment devoid of oxygen?



There are a couple I want to do that to....


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## JPINFV (Aug 10, 2011)

tickle me doe face said:


> what's wrong with that statement?


Oxygen itself is what is dangerous when it comes to radicals.  It's the reason why your body has catalase and peroxidase enzymes. It's  the reason for anti-oxidants. In fact, one of the few beneficial uses  your body has for radical oxygen species is to kill bacteria as part of  your bodies immune response. To say that oxygen is a "radical inhibitor"  shows such a profound misunderstanding of biology as saying the world  is flat is a misunderstanding of world geography.


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## squrt29batt12 (Aug 10, 2011)

JPINFV said:


> Demand your money back because your instructor(s) have obviously never heard of "science."



LOL


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## tickle me doe face (Aug 10, 2011)

sorry double post


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## tickle me doe face (Aug 10, 2011)

JPINFV said:


> Oxygen itself is what is dangerous when it comes to radicals.  It's the reason why your body has catalase and peroxidase enzymes. It's  the reason for anti-oxidants. In fact, one of the few beneficial uses  your body has for radical oxygen species is to kill bacteria as part of  your bodies immune response. To say that oxygen is a "radical inhibitor"  shows such a profound misunderstanding of biology as saying the world  is flat is a misunderstanding of world geography.



I'm not sure I understand. Couldn't/wouldn't an oxygen free radical couple with any other radical to annihilate 2 radicals, and thus inhibit the radical process? :unsure:


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## Cup of Joe (Aug 10, 2011)

JPINFV said:


> Just curious...
> 
> 1. By "withholding oxygen" do you mean to put a patient in an environment devoid of oxygen?
> 
> ...




NYS BLS Protocols (and as we are instructed)...in breathing section of initial assessment, every patient should be started on high flow oxygen via non-rebreather at 15lpm  If breathing is inadequate, ventilate with supplemental O2.

http://www.health.state.ny.us/nysdoh/ems/pdf/2008-11-19_bls_protocols

In response to #1:  withhold high flow oxygen.
In response to #2:  According to protocols and course material, if there's a patient (you know, not refusing treatment, etc.), then they get "high concentration oxygen."  

This is all according to the book and my protocols, which I believe would make it the "correct" answer.


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## tickle me doe face (Aug 10, 2011)

jcalNYC said:


> NYS BLS Protocols (and as we are instructed)...in breathing section of initial assessment, every patient should be started on high flow oxygen via non-rebreather at 15lpm  If breathing is inadequate, ventilate with supplemental O2.
> 
> http://www.health.state.ny.us/nysdoh/ems/pdf/2008-11-19_bls_protocols
> 
> ...



yeah we were told everyone gets high flow 02. 

actually is was more drilled into us than anything else.


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## CAOX3 (Aug 10, 2011)

JPINFV said:


> Demand your money back because your instructor(s) have obviously never heard of "science."



Come on now science has no place in medicine.

Emergency medical service is taught in garages and basements, we don't need no stinking classrooms.


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## Anjel (Aug 10, 2011)

Ive never put a pt on high flow o2. Ive taken someone off but never needed to put them on it


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## JPINFV (Aug 10, 2011)

jcalNYC said:


> NYS BLS Protocols (and as we are instructed)...in breathing section of initial assessment, every patient should be started on high flow oxygen via non-rebreather at 15lpm  If breathing is inadequate, ventilate with supplemental O2.
> 
> http://www.health.state.ny.us/nysdoh/ems/pdf/2008-11-19_bls_protocols


PDF page 12 (page GA 2)?

"Breathing – Assess breathing, administer oxygen *if necessary *and consider
positive pressure ventilations."

Emphasis added.


Additionally, from PDF page 5 (page Introduction 3):
"These protocols are not intended to be absolute and ultimate treatment doctrines, but rather standards which are flexible to accommodate the complexity of the problems in patient management presented to Emergency Medical Technicians (EMTs) and Advanced Emergency Medical Technicians (AEMTs) in the field. These protocols should be considered as a model or standard by which all patients should be treated. Since patients do not always fit into a "cook book" approach, these protocols are not a substitute for GOOD CLINICAL JUDGMENT, especially when a situation occurs which does not fit these standards."

So, even if it did say that (but it says "when appropriate"), the protocol book itself says, "If, based on good clinical judgement, you feel the need to deviate, then do so."


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## JPINFV (Aug 10, 2011)

tickle me doe face said:


> I'm not sure I understand. Couldn't/wouldn't an oxygen free radical couple with any other radical to annihilate 2 radicals, and thus inhibit the radical process? :unsure:



Molecular oxygen? No. If anything, if molecular oxygen interacts with a radical oxygen, it's going to absorb the radical and then immediately kick off a radical oxygen. Now if you somehow managed to administer oxygen with radicals in it, then the radical oxygen would be able to react with, and neutralize another radical, but at the same time you're going to be doing a huge amount of damage. 







Just due to how aerobic respiration occurs, your body naturally produces a low level of radicals, which is how radicals get started in your body. Under normal conditions, the chemical defenses your body has is able to handle them. These defenses, however, can become compromised.

Basically when molecular oxygen reacts with another radical, reaction 4 occurs. 

If two radical oxygen speices meet, then reaction 6 or 7 (I'm not sure why they're treated differently in this picture) occur. However, in order to do that you have to produce or supply more radicals, which leads to 4 being more likely with things that you'd rather not have undergo oxidative stress.


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## tickle me doe face (Aug 10, 2011)

JPINFV said:


> Molecular oxygen? No. If anything, if molecular oxygen interacts with a radical oxygen, it's going to absorb the radical and then immediately kick off a radical oxygen. Now if you somehow managed to administer oxygen with radicals in it, then the radical oxygen would be able to react with, and neutralize another radical, but at the same time you're going to be doing a huge amount of damage.
> 
> 
> 
> ...



That makes sense...

is molecular oxygen a radical?


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## Cup of Joe (Aug 10, 2011)

JPINFV said:


> PDF page 12 (page GA 2)?
> 
> "Breathing – Assess breathing, administer oxygen *if necessary *and consider
> positive pressure ventilations."
> ...



The book is the book and the street is the street.  Obviously the protocols are flexible.  Yes, the "general approach" does say "if necessary." My class has told us to administer high flow O2 during initial assessment.  The protocols say it under each scenario.  So for poisoning, for example, it says administer oxygen (as step 1 for swallowed poisons, step 6 for inhaled poisons, and 'C' for unresponsive or altered mental poisonings).

We could argue about this for days, considering that lawyers probably went through this with a fine tooth comb looking for things like this.  

Ultimately, none of my instructors would ever say that at the BLS level (specifically on a test), we should not give a patient high flow oxygen.  And according to a lot of people on this forum and in the real world as well, it can be debated whether EMT-Bs possess enough medical knowledge to make "good clinical judgement."


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## medichopeful (Aug 10, 2011)

tickle me doe face said:


> also I remember reading that paraquat is an organo-pesticide that was used primarily in mexico, to kill marijuana plants in the 1970's, which i thought added to my guess that paraquat was not the answer he was seeking.



It still exists in some countries, and is sometimes used by individuals in 3rd world countries to commit suicide.


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## usalsfyre (Aug 10, 2011)

To answer the original question, giving high-concentration O2 to a neonate who is PDA dependent (any of the cyanotic heart lesions) would be pretty rapidly fatal as well.


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## tickle me doe face (Aug 10, 2011)

tickle me doe face said:


> That makes sense...
> 
> is molecular oxygen a radical?




like in this picture:






it shows di-radical oxygen, and stable oxygen is crossed out, as if molecular oxygen most commonly exists in the di-radical conformation?


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## JPINFV (Aug 10, 2011)

Atomic oxygen is (O1), but is basically non-existent on earth. Molecular oxygen has no unpaired electrons, but will easily react to form a radical.


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## JPINFV (Aug 10, 2011)

tickle me doe face said:


> like in this picture:
> 
> 
> 
> ...



Looking at the page it comes from, it looks like they're saying nothing more than "this can occur, and this is abnormal." The oxygen you're breathing and what's in your oxygen tank is what's on the right.


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## tickle me doe face (Aug 10, 2011)

JPINFV said:


> Atomic oxygen is (O1), but is basically non-existent on earth. Molecular oxygen has no unpaired electrons, but will easily react to form a radical.



I thought that molecular oxygen was one of those nasty little exceptions, where it doesn't agree with lewis theory.

don't several empirical observations, such as it being paramagnetic support molecular oxygen having a bond order of one instead of two as predicted by lewis dot theory?


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## JPINFV (Aug 10, 2011)

usalsfyre said:


> To answer the original question, giving high-concentration O2 to a neonate who is PDA dependent (any of the cyanotic heart lesions) would be pretty rapidly fatal as well.



Not as bad as prostaglandins...


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## usalsfyre (Aug 10, 2011)

JPINFV said:


> Not as bad as prostaglandins...



True...but I'm not sure NSAIDs is gonna be on the list of "ways EMS can kill the neonate"...

Heck our pediatrician was anti-NSAID for the first year of life.


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## tickle me doe face (Aug 10, 2011)

I think MO theory would show oxygen to be diradical right?


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## JPINFV (Aug 10, 2011)

jcalNYC said:


> The book is the book and the street is the street.  Obviously the protocols are flexible.  Yes, the "general approach" does say "if necessary." My class has told us to administer high flow O2 during initial assessment.  The protocols say it under each scenario.  So for poisoning, for example, it says administer oxygen (as step 1 for swallowed poisons, step 6 for inhaled poisons, and 'C' for unresponsive or altered mental poisonings).



That's because the NREMT has, for unknown reasons, a proverbial hard-on for administering a high concentration of oxygen. If it was appropriate, how come not everyone in the emergency department is chilling with a NRB on? 




> Ultimately, none of my instructors would ever say that at the BLS level (specifically on a test), we should not give a patient high flow oxygen.  And according to a lot of people on this forum and in the real world as well, it can be debated whether EMT-Bs possess enough medical knowledge to make "good clinical judgement."



So if I called 911 because I stubbed a toe, your instructors would put me on a NRB? 

Ok, then follow the protocol to a T. The initial assessment section still says, "when appropriate" and the later protocols specifically say "high concentration of oxygen." If you want to play the protocol book game, then it's appropriate when utilizing one of those specific protocols.


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## Shishkabob (Aug 10, 2011)

Anjel1030 said:


> Ive never put a pt on high flow o2. Ive taken someone off but never needed to put them on it



Every single person I've ever put an NRB on as a Paramedic has ended up getting intubated.


Just sayin'.


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## JPINFV (Aug 10, 2011)

tickle me doe face said:


> I think MO theory would show oxygen to be diradical right?




No, because molecular oxygen has a double bond. So you have 2 pairs of unbounded electrons on each molecule as well as a sigma bond and a pi bond linking the two oxygen molecules.


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## usalsfyre (Aug 10, 2011)

JPINFV said:


> Not as bad as prostaglandins...



Prostglandins would be APPROPRIATE for a PDA I thought...NSAIDS would be fatal as they inhibit prostaglandin synthesis. Am I wrong?


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## JPINFV (Aug 10, 2011)

usalsfyre said:


> True...but I'm not sure NSAIDs is gonna be on the list of "ways EMS can kill the neonate"...
> 
> Heck our pediatrician was anti-NSAID for the first year of life.




Hehe... I think I got my edit in before you hit the quote button. NSAIDS are used to close PDAs (which is good when the PDA isn't needed. PDAs aren't necessarily bad). Prostaglandins, on the other hand...


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## JPINFV (Aug 10, 2011)

usalsfyre said:


> Prostglandins would be APPROPRIATE for a PDA I thought...NSAIDS would be fatal as they inhibit prostaglandin synthesis. Am I wrong?



Prostaglandins keep it open, NSAIDs prevents prostaglandin production, which is helpful if you're looking to close it.


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## usalsfyre (Aug 10, 2011)

JPINFV said:


> Prostaglandins keep it open, NSAIDs prevents prostaglandin production, which is helpful if you're looking to close it.



Yeah but if you've got a kid with say TOF, NSAIDS would be like giving epi to someone having a good sized MI.


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## JPINFV (Aug 10, 2011)

usalsfyre said:


> Yeah but if you've got a kid with say TOF, NSAIDS would be like giving epi to someone having a good sized MI.



TOF? Meh. It's helpful, but you aren't going to close all of the routes. Now Transposition of the Great Vessels? It's a death warrant.


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## tickle me doe face (Aug 10, 2011)

JPINFV said:


> No, because molecular oxygen has a double bond. So you have 2 pairs of unbounded electrons on each molecule as well as a sigma bond and a pi bond linking the two oxygen molecules.



but if O2 had no unpaired electrons it wouldn't be able to interact with a magnetic field right? 

also i thought that if you you drew molecular oxygen and started adding it's electrons, the very last 2 would go into degenerate p orbitals, and since every single orbital must be occupied before electrons start pairing off, the end structure would have 2 unpaired electrons?


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## fast65 (Aug 10, 2011)

Linuss said:


> Every single person I've ever put an NRB on as a Paramedic has ended up getting intubated.
> 
> 
> Just sayin'.



Same here...well except the guy yesterday, I had the Sux and Roc all drawn up and then I didn't even get to use them


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## usalsfyre (Aug 10, 2011)

JPINFV said:


> TOF? Meh. It's helpful, but you aren't going to close all of the routes. Now Transposition of the Great Vessels? It's a death warrant.


Transposition of the Great Vessels was covered superficially in the stuff I just finished studying. My impression was those kids rarely make it past the first hour or so.


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## JPINFV (Aug 10, 2011)

1 S and 2 S is going to fill before 2P fills. So atomic oxygen is going to have 2 unpaired electrons in the 2 P shell. However, since you get a double bond with molecular oxygen, each oxygen molecule is going to share 2 electrons with each other, which will allow you to fill the 2 P shell.


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## tickle me doe face (Aug 10, 2011)

tickle me doe face said:


> but if O2 had no unpaired electrons it wouldn't be able to interact with a magnetic field right?
> 
> also i thought that if you you drew molecular oxygen and started adding it's electrons, the very last 2 would go into degenerate p orbitals, and since every single orbital must be occupied before electrons start pairing off, the end structure would have 2 unpaired electrons?



like in this pucture?


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## JPINFV (Aug 10, 2011)

usalsfyre said:


> Transposition of the Great Vessels was covered superficially in the stuff I just finished studying. My impression was those kids rarely make it past the first hour or so.



It's a "get to the OR... NOW" situation. I'm honestly not sure, though, what the mortality rate is.


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## Cup of Joe (Aug 10, 2011)

JPINFV said:


> That's because the NREMT has, for unknown reasons, a proverbial hard-on for administering a high concentration of oxygen. If it was appropriate, how come not everyone in the emergency department is chilling with a NRB on?



Because the book is the book, and the street is the street.  On the street, EMTs are exhibiting their "good clinical judgement" when they don't follow protocol word for word.  When you take a class, they teach you to pass a test.  And if the NREMT tests to the idea that everyone gets oxygen, then the class teaches you that everyone gets oxygen.




JPINFV said:


> So if I called 911 because I stubbed a toe, your instructors would put me on a NRB?
> 
> Ok, then follow the protocol to a T. The initial assessment section still says, "when appropriate" and the later protocols specifically say "high concentration of oxygen." If you want to play the protocol book game, then it's appropriate when utilizing one of those specific protocols.



The tests tell you you should.  Utilizing good clinical judgement, it can be debated whether you need it or not, which is why we wouldn't give it unless indicated.  

As to following specific protocols, they're there as a model.  Every patient is different and some may not even fit the model, which is why the state writes that it is not a substitute for good clinical judgement.


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## JPINFV (Aug 10, 2011)

Huh... looking at the page source for that (http://courses.chem.psu.edu/chem210/) is interesting and leads me to believe that you know more than you let on. I honestly don't remember if it was presented similar to that during undergrad chem and o-chem (we're talking 6 years ago). However, it also shows why oxygen isn't as safe as it's made out to be. Finally, it's not nearly reactive as a radical alone.


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## the_negro_puppy (Aug 11, 2011)

For us supplemental 02 is contraindicated for lung disease secondary to bleomycin therapy and known paraquat poisoning.

Paraquat>


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## tickle me doe face (Aug 11, 2011)

the_negro_puppy said:


> For us supplemental 02 is contraindicated for lung disease secondary to bleomycin therapy and known paraquat poisoning.
> 
> Paraquat>



not even a little bit?

even if they are severly hypoxic?


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## mikie (Aug 11, 2011)

*sad part is...i knew the answer*

according to the Mosby paramedic pharmacology flashcards, the only contraindication to O2 is indeed "known" paraquat poisoning.


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## tickle me doe face (Aug 11, 2011)

*I'm so lost now....*

Wait, I'm confused again :blink:

basically, doesn't paraquat accumulate in alveolar epithelial cells, and cause damage through a mechanism that generates oxygen free radicals?

And if that is the case, and o2 was administered, and if o2 is triplet o2, and is di radical, why wouldn't it couple with the radicals generated via the paraquat and terminate the radical process?

Or if O2 was singlet o2, which is a known ROS, still terminate radical polymerization?

By that way of thinking how can o2 be contraindicated in paraquat poisoning???:unsure:

It sure seems like o2 would "eat up" oxygen free radicals resulting from the paraquat?

I'm getting really nervous for my upcoming NREMT now....


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## JPINFV (Aug 11, 2011)

I honestly can't comment on why O2 doesn't, on a regular basis and spontaneously, form O3 (not that ozone is the healthiest thing to breath anyways) instead of simply splitting off to form a new radical, but it doesn't. I do know that O2 loves making radicals when it can, and that when it gets hit with a radical it tends to make radicals. 

In terms of atomic oxygen (O1), yes, when it gets hit with a radical it will neutralize it. The problem is that it also can hit other molecules and make those into radicals, which can cause problems.


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## Cup of Joe (Aug 11, 2011)

JPINFV said:


> I honestly can't comment on why O2 doesn't, on a regular basis and spontaneously, form O3 (not that ozone is the healthiest thing to breath anyways) instead of simply splitting off to form a new radical, but it doesn't. I do know that O2 loves making radicals when it can, and that when it gets hit with a radical it tends to make radicals.



Because O2 is stable as is?  All the electrons are pair with another electron so it has no need to bond with another atom?  Thats my guess.


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## akflightmedic (Aug 11, 2011)

tickle me doe face said:


> Wait, I'm confused again :blink:
> 
> basically, doesn't paraquat accumulate in alveolar epithelial cells, and cause damage through a mechanism that generates oxygen free radicals?
> 
> ...



Sock puppet strikes!


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## samiam (Aug 13, 2011)

usalsfyre said:


> To answer the original question, giving high-concentration O2 to a neonate who is PDA dependent (any of the cyanotic heart lesions) would be pretty rapidly fatal as well.



When I was born I came out blue and was put on O2 even though I had a PDA... What is the mechanism behind that?


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## Aidey (Aug 13, 2011)

He specified high concentration O2, not O2 period. We occasionally transport out of town teams, and we had a neonate with transposition of the great vessels who was on .5lpm O2.


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## usalsfyre (Aug 13, 2011)

samiam said:


> When I was born I came out blue and was put on O2 even though I had a PDA... What is the mechanism behind that?



The ductus arteriosis is supposed to be closed via oxygenation at birth, the issue is when infants require a PDA to mix in oxygenated blood due to congenital abnormalities.


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## silver (Aug 13, 2011)

usalsfyre said:


> The ductus arteriosis is supposed to be closed via oxygenation at birth, the issue is when infants require a PDA to mix in oxygenated blood due to congenital abnormalities.



Yep these ductal dependent lesions include Tetralogy of Fallot, pulmonary atresia/stenosis, and transposition of the great vessels. Closing the PDA, giving O2, would not be good...


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## nwhitney (Aug 13, 2011)

Was there ever an answer to the original question or are folks still going on about administering O2?


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## samiam (Aug 13, 2011)

silver said:


> Yep these ductal dependent lesions include Tetralogy of Fallot, pulmonary atresia/stenosis, and transposition of the great vessels. Closing the PDA, giving O2, would not be good...



Gotcha!  Thanks!


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## crazycajun (Aug 13, 2011)

tickle me doe face said:


> Wait, I'm confused again :blink:
> 
> basically, doesn't paraquat accumulate in alveolar epithelial cells, and cause damage through a mechanism that generates oxygen free radicals?
> 
> ...



HOLY CRAP!!!!! Welcome back Medic Rob!!!!!!


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## Anjel (Aug 13, 2011)

crazycajun said:


> HOLY CRAP!!!!! Welcome back Medic Rob!!!!!!



I love that you always say what im thinking. Esp cuz that poster is from nashville.


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## Aidey (Aug 13, 2011)

And the avatar...


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## Sasha (Aug 13, 2011)

I believe its lifeguards come back to eff with us. Medicrob would be smarter than that.

Sent from LuLu using Tapatalk


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## crazycajun (Aug 13, 2011)

Sasha said:


> I believe its lifeguards come back to eff with us. Medicrob would be smarter than that.
> 
> Sent from LuLu using Tapatalk



Actually I think Medic Rob would not want to show he is too smart. It would be too obvious. I do thin Lifeguards is still floating around though. His post are usually very stupid.


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## lightsandsirens5 (Aug 13, 2011)

This thread is not to talk about people who have left the forum or who have been banned. Matter of fact no thread is. Do not accuse anyone of being someone else. If you have suspicions, please report them to the CLs and then leave it be. 

One more off topic post and this thread is kaput. 

Thank you.


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## McGoo (Aug 13, 2011)

nwhitney said:


> Was there ever an answer to the original question or are folks still going on about administering O2?



Yep, I believe the answer was paraquat poisoning, a herbicide used on farms. It's still sold in Australia at least, it's mixed with diquat and sold as Sprayseed, a fairly cheap herbicide that will kill every plant it touches.


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## Hunter (Aug 14, 2011)

I was told by an instructor that highflow oxygen causes Vasoconstriction and that we should put Ischemic Stroke patients on Nasal Canulas instead of NRB. however thats not poisoning...


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## usafmedic45 (Aug 14, 2011)

tickle me doe face said:


> I realize COPD is not a type of poisoning, but it was the best condition I could come up with.
> 
> :blush:



Neither COPD nor paraquat poisoning will be "instantly fatal" if you give oxygen.  COPD patients are not harmed by short term high flow oxygen therapy in any meaningful way (other than the aforementioned free radical production, etc).  The idea of hypoxic drive has been disproved time and time again.



> It sure seems like o2 would "eat up" oxygen free radicals resulting from the paraquat?



I find your lack of basic chemistry and physiology knowledge disturbing.



> I'm getting really nervous for my upcoming NREMT now....



LOL There won't be any questions about this on there.


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## RocketMedic (Aug 15, 2011)

If the fairly miniscule amount of constriction that o2 generates is enough to block primary cerebral perfusion, your patient is going to die. The circle of Willis and the associated vasculature are large, high flow systems.


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## Aidey (Aug 15, 2011)

Who said anything about blocking primary cerebral perfusion? Blocking cerebral perfusion at any point can lead to permanent deficits. It isn't just about not killing your patients, but also about not increasing any deficit/damage they may have.


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## usalsfyre (Aug 15, 2011)

Rocketmedic said:


> The circle of Willis and the associated vasculature are large, high flow systems.



But the circulation feeding the infarcted or injured area often are not. And if ICP is already increased it may not take that much to cut of circulation to the point of leading to large deficits/ more global secondary injury.


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## usafmedic45 (Aug 15, 2011)

JPINFV said:


> It's a "get to the OR... NOW" situation. I'm honestly not sure, though, what the mortality rate is.



~5% with surgery, about 95% within first year of life without it.  It's not always a "GET TO THE OR....NOW" situation, although it's not something you want to **** around with.


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## 04_edge (Aug 15, 2011)

Hypoplastic Left Heart Syndrome (HLHS) in a newborn, its not a poison, but its the only think i can think of that really has the potential for this to happen.

Presentation would be a cyanotic will low 02 sats, although because of the likely hood of this happening is VERY small, and recognizing it in the field even less, i would never withold 02 from a neworn. I did a research paper on it during paramedic school, i dont remember the exact reasoning, but basically the only thing keeping them alive is the defect itself, and 02 speeds up the closing of one of the openings in the heart and will not allow blood to flow into the lungs IIRC


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## silver (Aug 15, 2011)

04_edge said:


> Hypoplastic Left Heart Syndrome (HLHS)
> 
> ...
> 
> i dont remember the exact reasoning, but basically the only thing keeping them alive is the defect itself, and 02 speeds up the closing of one of the openings in the heart and will not allow blood to flow into the lungs IIRC



that would be the patent ductus arteriosus. We discussed some about it earlier in the thread, though its not like an instant closure...


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