Okay, I have a slightly different perspective on this, there is one true contra-indication for O2 admin, that would be paraquat poisoning.
New EMT, don't understand a couple of calls.
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Okay, I have a slightly different perspective on this, there is one true contra-indication for O2 admin, that would be paraquat poisoning.
EMTinNEPA
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No problem.
reaper
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There is no true contraindication for Oxygen, in the emergency setting. Yes, Paraquat poisoning should be handled with care. But, if they need O2, they need O2. Hypoxia will kill faster the then the Paraquat!
Paraquat poisoning will be further along with high concentrations of O2, there is no doubt about this, I can find plenty of sources all over the internet. In emergency care if someone needs help with their breathing, bag them on room air, that is assisting their ventilations to some point. I will concede that it is not ideal, but I would suggest that is a true contraindication. If you give 100% O2 at 15 lpm, then I would say that would be EMS assisted suicide.
adamjh3
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Shoes, I would like to see a couple sources if you wouldn't mind, I've done a quick search and turned up nothing to support either side.
Lifeguards For Life
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No specific contraindications to oxygen therapy exist when indications are judged to be present.
Paraquat has an affinity for the lung, in which it is selectively absorbed and accumulates within type I and type II alveolar epithelial cells. Within these cells, paraquat generates oxygen free radicals that ultimately damage lipid membranes and cause cell death. The initial acute lung injury may progress to acute respiratory distress syndrome. Those patients who do survive enter a proliferative phase characterized by loss of alveolar integrity, proliferation of fibroblasts, and deposition of collagen, leading to pulmonary fibrosis.
Ironically, oxygen supplementation may have a deleterious effect because it increases the number of toxic radicals. Oxygen should therefore be given only to prevent hypoxemia. Anoxic injury will be much more harmfull to the patient than damage to pulmonary parenchyma.
The poison control center does not advise withholding oxygen, to patients with suspected paraquat poisoning.
Take everything you are told in school with a grain of salt. Oxygen, even 15lpm is not a death sentence in any form of dipyridyl compounds poisonings.
"In which form of organophosphate poisoning is oxygen immediately lethal?", has long been a 'fad' EMS question, with many providers claiming paraquat, with little to no understanding of why.
so a few things first and fore most; The hypoxemia definition as decreased partial pressure of oxygen excludes decreased oxygen content caused by anemia (decreased content of oxygen binding protein hemoglobin) or other primary hemoglobin deficiency, because they don't decrease the partial pressure of oxygen in blood.
Still, some simply define it as insufficient oxygenation or total oxygen content of (arterial) blood, which, without further specification, would include both concentration of dissolved oxygen and oxygen bound to hemoglobin. Inclusion of the latter would include anemia as a possible cause of hypoxemia (which, however, is not the case generally). And such hypoxia is referred to as hypoxemic hypoxia, which is distinguished from e.g. anemic hypoxia. Because of the frequent incorrect use of hypoxemia, this is sometimes erroneously stated as hypoxic hypoxia. source: wikipedia and just in case there is an issue with wiki here is another one, The main symptom of hypoxemia is shortness of breath, but depending on how quickly hypoxemia develops, you may experience a reduced capacity for exercise, fatigue and confusion. source:mayoclinic.com
the biggest point that I am trying to make here is that oxygen is not indicated in cases of paraquat poisoning. it is not going to help, life even in the same article that you posted, which you copied and pasted into a response to this, says not to with hold but no where in the article does it say you can't use room air or if their is a certain amount of oxygen delivered to these pt's. Along the same lines though the Hypoxemia is different from hypoxia, which is an abnormally low oxygen availability to the body or an individual tissue or organ. Still, hypoxia can be caused by hypoxemia. Source wikipedia.
I don't believe everything that I hear in class until i have time to research a subject on my own. although I will say this much paraquat is unlikely to be seen to much here in America seeing as for the most part it has been outlawed and the few places that do use need to have a licensed person apply this product.
Life I will also say that for the most part oxygen should never be with held from a pt that does actually need it. but at the same time a lot of EMS providers think oxygen should always be applied no matter what. the purpose of this to me was to high light maybe just maybe that oxygen doesn't need to be delivered. But since I have said that paraquat is for the most part been outlawed in the US then in a way we are both right.
Still, some simply define it as insufficient oxygenation or total oxygen content of (arterial) blood, which, without further specification, would include both concentration of dissolved oxygen and oxygen bound to hemoglobin. Inclusion of the latter would include anemia as a possible cause of hypoxemia (which, however, is not the case generally). And such hypoxia is referred to as hypoxemic hypoxia, which is distinguished from e.g. anemic hypoxia. Because of the frequent incorrect use of hypoxemia, this is sometimes erroneously stated as hypoxic hypoxia. source: wikipedia and just in case there is an issue with wiki here is another one, The main symptom of hypoxemia is shortness of breath, but depending on how quickly hypoxemia develops, you may experience a reduced capacity for exercise, fatigue and confusion. source:mayoclinic.com
the biggest point that I am trying to make here is that oxygen is not indicated in cases of paraquat poisoning. it is not going to help, life even in the same article that you posted, which you copied and pasted into a response to this, says not to with hold but no where in the article does it say you can't use room air or if their is a certain amount of oxygen delivered to these pt's. Along the same lines though the Hypoxemia is different from hypoxia, which is an abnormally low oxygen availability to the body or an individual tissue or organ. Still, hypoxia can be caused by hypoxemia. Source wikipedia.
I don't believe everything that I hear in class until i have time to research a subject on my own. although I will say this much paraquat is unlikely to be seen to much here in America seeing as for the most part it has been outlawed and the few places that do use need to have a licensed person apply this product.
Life I will also say that for the most part oxygen should never be with held from a pt that does actually need it. but at the same time a lot of EMS providers think oxygen should always be applied no matter what. the purpose of this to me was to high light maybe just maybe that oxygen doesn't need to be delivered. But since I have said that paraquat is for the most part been outlawed in the US then in a way we are both right.
Something new to throw into the mix:
A study at Cooper Union Hospital showed increased post cardiac arrest survival rates with lower levels of O2 - better with sp02 <90 than with sp02 at 100, best with sp02 94-96.
http://www.emsresponder.com/article/article.jsp?id=13503&siteSection=1
A study at Cooper Union Hospital showed increased post cardiac arrest survival rates with lower levels of O2 - better with sp02 <90 than with sp02 at 100, best with sp02 94-96.
http://www.emsresponder.com/article/article.jsp?id=13503&siteSection=1
reaper
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Has already been mentioned in a seperate thread.
Take little from a study conducted at one hospital. Some thing like that would need a broad study done.
Take little from a study conducted at one hospital. Some thing like that would need a broad study done.
OP
OP
VirginiaEMT
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WOW, this is the BLS discussion board isn't it.
JPINFV
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EMT-Bs administer oxygen, correct?
O2. What exactly is it doing?
Not directed at anyone, but food for thought.
"When it is needed" is exactly the point.
Lets look at blood loss from trauma. There is a great push to find something that will transport and gie up oxygen in the body.
If you add 15L of NRB but losing the blood that carries the oxygen, all you are doing is adding free radicals. Can we agree that adding oxygen when there is no ability to transport it to tissues doesn't really do anything productive?
consider any shock for that matter.
Look at the plethora of airway diseases where o2 intake is not the issue. If there is already enough O2, how does adding more help?
Forget hypoxic drive, and all the myth surrounding that, if you have one functioning alveoli out of 10 or more, does adding oxygen increase the surface area for gas exchange? How?
Want to see? get a straw and some bubbles. Put one bubble on one end of the straw and a second bubble opposite. They don't equal in pressure, one gets smaller and one gets bigger.
What about oxygen as a vasoconstrictor? Does constricting coronary arteries in an ACS seem like it would be of benefit?
EMS relly boarders on snake oil sales. Mythological magical traditions and catch phrases that withstand evidence to the contrary. Is that the mark of medical professionalism?
"If some is good more is better???"
I am not suggesting oxygen, even at 10L NRB never helps, only that there are relatively few times it does.
It is nice to turn phrases like "don't withold when needed." But with such little need, perhaps withholding is a better standard than flooding in all cases?
Not directed at anyone, but food for thought.
"When it is needed" is exactly the point.
Lets look at blood loss from trauma. There is a great push to find something that will transport and gie up oxygen in the body.
If you add 15L of NRB but losing the blood that carries the oxygen, all you are doing is adding free radicals. Can we agree that adding oxygen when there is no ability to transport it to tissues doesn't really do anything productive?
consider any shock for that matter.
Look at the plethora of airway diseases where o2 intake is not the issue. If there is already enough O2, how does adding more help?
Forget hypoxic drive, and all the myth surrounding that, if you have one functioning alveoli out of 10 or more, does adding oxygen increase the surface area for gas exchange? How?
Want to see? get a straw and some bubbles. Put one bubble on one end of the straw and a second bubble opposite. They don't equal in pressure, one gets smaller and one gets bigger.
What about oxygen as a vasoconstrictor? Does constricting coronary arteries in an ACS seem like it would be of benefit?
EMS relly boarders on snake oil sales. Mythological magical traditions and catch phrases that withstand evidence to the contrary. Is that the mark of medical professionalism?
"If some is good more is better???"
I am not suggesting oxygen, even at 10L NRB never helps, only that there are relatively few times it does.
It is nice to turn phrases like "don't withold when needed." But with such little need, perhaps withholding is a better standard than flooding in all cases?
EMTinNEPA
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jjesusfreak01
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Are you sure we don't need to call in to use O2?
EMTinNEPA
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OP
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VirginiaEMT
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I realize that this has been :deadhorse: but, I think that the more EMT's see/read/hear about, maybe just maybe it might cause them to look things up and do some of their own research on different subject. Just because it isn't taught in an EMT basic program doesn't mean they don't need to know about it.
jjesusfreak01
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Verified hyperventilation...
We can withhold Oxygen in the case of verified hyperventilation, right?
So long as we verify with spO2 and there are no indications of other pulmonary or cardiac problems, we can withhold it?
We can withhold Oxygen in the case of verified hyperventilation, right?
So long as we verify with spO2 and there are no indications of other pulmonary or cardiac problems, we can withhold it?