Oxygen D tank refilling

[Achilles]

Correct. Welding O2 isn't guaranteed to be of the same purity as it would be if it's USP O2. (USP = United States Pharmacopeia). On the other hand, it's entirely possible that the oxygen you get from a welding gas supplier is actually USP, but just isn't labeled that way.

Where you get the Oxygen, USP or otherwise, is quite likely a welding gas supplier. When I worked in the San Jose area, we used to get our medical gasses from Airgas. They're a welding gas supplier, but they also had a medical gas product line...

We had a cascade system for filling our D tanks if we were running low on filled Jumbo-D tanks. We preferred (by far) to have Airgas do the filling though. If we had to use the cascade system, it was because we'd run out and hadn't gotten any tanks back from Airgas. It was a system that worked pretty well.

Just like when a fire department purchases a saw right?
It's fire grade because it says fire on it and adds 50$ to the price but its really no different from the saw that doesn't say fire on it.

 

[NomadicMedic]

Just like when a fire department purchases a saw right?
It's fire grade because it says fire on it and adds $300 to the price but its really no different from the saw that doesn't say fire on it.

Fixed that for you.

 

[Tigger]

Ummmm. No? I can tell my pt ( not an arrest pt of course) to take couple deep breaths and it goes up within seconds.

I can put it on myself and hold my breath and watch it fall just as rapidly.

We use it per protocol to watch for over oxygenation during arrests at the beginning of CPR while it be trauma or medical while you are setting up your King etc etc. While it is true you expect o2 levels to be down at the beginning, our service prefers to monitor. If it will take time away from CPR, then we can skip it

Studies show you have a less of a chance of permanent brain injury if you keep o2 SATs between 93 and 95 etc etc. .

The five to six minutes came from a Bob Page talk about capnography. Since I cannot find a citation, I will rescind it.

Nonetheless there is plenty of evidence that there is a delay, and it can be significant. This is especially true with patients in extremis as they are likely to not be perfusing well enough to get an accurate oximetry reading. I have found several papers that state that pulse oximetry is not at all helpful in cardiac arrest as surprise, these patients are not perfusing well. On my last few ROSCs we weren't even able to get a SpO2 reading as the patients were still so poorly perfused, even after the addition of pressors. I would like to read those studies you mentioned above as I am not sure how the authors went about obtaining their data.

All told, it really isn't as useful of a tool as it is made out to be. Are you aware of what pulse oximetry measures? Hint: it is not the oxygen saturation level of blood. What does that tell you?

Here's a good overview, note the author's opinion about its use in cardiac arrest. I have more studies and articles on the subject if you'd like.

Sorry, still part of protocol, yes we use etco2 once established.

As many have said here before, there are few dirtier phrases in EMS than justifying an action or intervention based only on "it's protocol." If you don't understand why you are doing something, you shouldn't be doing it. No excuses.

 

[ffemt8978]

The five to six minutes came from a Bob Page talk about capnography. Since I cannot find a citation, I will rescind it.

Nonetheless there is plenty of evidence that there is a delay, and it can be significant. This is especially true with patients in extremis as they are likely to not be perfusing well enough to get an accurate oximetry reading. I have found several papers that state that pulse oximetry is not at all helpful in cardiac arrest as surprise, these patients are not perfusing well. On my last few ROSCs we weren't even able to get a SpO2 reading as the patients were still so poorly perfused, even after the addition of pressors. I would like to read those studies you mentioned above as I am not sure how the authors went about obtaining their data.

All told, it really isn't as useful of a tool as it is made out to be. Are you aware of what pulse oximetry measures? Hint: it is not the oxygen saturation level of blood. What does that tell you?

Here's a good overview, note the author's opinion about its use in cardiac arrest. I have more studies and articles on the subject if you'd like.



As many have said here before, there are few dirtier phrases in EMS than justifying an action or intervention based only on "it's protocol." If you don't understand why you are doing something, you shouldn't be doing it. No excuses.

Even if your Medical Director wants it done that way?

 

[Mariemt]

Even if your Medical Director wants it done that way?

It is not a dangerous or potentionally harmful protocol at that. It is one we pit on as we are putting our fast patches on.
Seriously Tigger. I think there are bigger fish to fry than nit picking at that one

 

[Tigger]

Even if your Medical Director wants it done that way?

Talk to your medical director if you don't understand why you are doing something. At least you will have his take, though it's obviously not infallible.

It is not a dangerous or potentionally harmful protocol at that. It is one we pit on as we are putting our fast patches on.
Seriously Tigger. I think there are bigger fish to fry than nit picking at that one

I'm just pointing out that the literature shows it to be useless in cardiac arrest. There are best practices out there and it's worth researching what they are. If you don't want to use them, that's too bad.

 

[Mariemt]

Talk to your medical director if you don't understand why you are doing something. At least you will have his take, though it's obviously not infallible.



I'm just pointing out that the literature shows it to be useless in cardiac arrest. There are best practices out there and it's worth researching what they are. If you don't want to use them, that's too bad.

I understand during cardiac arrest your body won't be profusing etc.
We are using the pulse ox for reoxygenation. Maybe we are hopeful we are going to bring this patient back.
This is not a protocol I am worried about addressing.

 

[TheLocalMedic]

I still don't know why anyone would want to have their own O2 bottle...

And I suggest that anyone who carries their own tank should also have a corresponding "BEWARE: I'M AN EMS WHACKER" decal on their vehicle.

 

[IslandTime]

I still don't know why anyone would want to have their own O2 bottle...

A lot depends on where one is located. We are a rural combined department with volunteer EMTs. Oops, I guess that's a couple strikes against us. Our EMTs carry oxygen in their vehicles. AEDs are carried by a variety of folks, both EMT and firefighter. The bottom line is our ability to get emergency care on scene as quickly as possible. The difference can be quite pronounced. We might have an individual on scene within a few minutes while the ALS rig is still 10-15 minutes away.

Having said that, I think there is a huge difference between deciding to go out and buy/carry an O2 bottle on your own Vs being issued one by your company/department.

 

[TheLocalMedic]

The bottom line is our ability to get emergency care on scene as quickly as possible. The difference can be quite pronounced. We might have an individual on scene within a few minutes while the ALS rig is still 10-15 minutes away.

Okay, you have a point there. I suppose in a setting that is rural enough, there may be some justification...

But the OP's location says NYC... hardly rural. My whacker radar is still pinging...

 

[IslandTime]

Okay, you have a point there. I suppose in a setting that is rural enough, there may be some justification...

But the OP's location says NYC... hardly rural. My whacker radar is still pinging...

Good point. I'd forgotten about that part. Target dead ahead, 2,000 yards and closing.

 

[Miscusi]

Good point. I'd forgotten about that part. Target dead ahead, 2,000 yards and closing.

I honestly think its just cool to have for the first aid kit at home. and the price is not unreasonable. and it lasts forever if you don't use it, so....

 

[Achilles]

I honestly think its just cool to have for the first aid kit at home. and the price is not unreasonable. and it lasts forever if you don't use it, so....

Still needs to be hydro tested every X amount of years

 

[ffemt8978]

I honestly think its just cool to have for the first aid kit at home. and the price is not unreasonable. and it lasts forever if you don't use it, so....

Then you're wanting it for the wrong reasons...

And to the rest of our members, take it easy on the anti-whacker responses. If you feel the need to post one, make sure it is polite and civil....otherwise I will be swinging the ban stick.

 

[Miscusi]

Still needs to be hydro tested every X amount of years

My research indicates that should the test date come, it does not have to be tested until you are done using it. then it must be tested before it is refilled. there is no need to empty a tank just to have it tested. ( what a waste )

let me pause here where I find a link...

here: "If a cylinder is in use (filled or partially filled with oxygen) and it reaches its retest date, there is no requirement to pull the cylinder from use or empty the cylinder to facilitate retesting. The cylinder can stay in use until it is emptied. There is no time limit for keeping the cylinder in use. After the cylinder is emptied, it must be tested before it can be refilled and transported."

from the US ARMY medical dept:

http://www.usamma.amedd.army.mil/assets/docs/oxygen cylinder markings.pdf

 

[ffemt8978]

Military hydorstatic testing requirements are different than civilian testing requirements.

 

[Miscusi]

Then you're wanting it for the wrong reasons...

It may not be your reason, but I cant say my reason, which is to have one in my first aid kit in case it is needed in an emergency, is wrong.

I think my reason is actually very right !

Being how there is no shortage of cylinders out there, my purchase will not deprive any particular sector of a cylinder.

And as a trained individual, should a human being happen to be in need if emergency first aid oxygen, I can really help him out.

I can see no wrong in that...

 

[Miscusi]

Military hydorstatic testing requirements are different than civilian testing requirements.

that definitely sparked my interest and will do more research...

 

[ffemt8978]

It may not be your reason, but I cant say my reason, which is to have one in my first aid kit in case it is needed in an emergency, is wrong.

I think my reason is actually very right !

Being how there is no shortage of cylinders out there, my purchase will not deprive any particular sector of a cylinder.

And as a trained individual, should a human being happen to be in need if emergency first aid oxygen, I can really help him out.

I can see no wrong in that...

That's not what you said...you said

I honestly think its just cool to have for the first aid kit at home. and the price is not unreasonable. and it lasts forever if you don't use it, so....

And do you not see a problem in administering a drug without a license to do so (and yes, oxygen is considered a drug)?

But let's run down the list of potential problems with this idea:

1) Regulator - you're going to need to buy one of these and it may or may not have to be inspected
2) Tubing - this stuff has a shelf life, so you will be buying replacements over time.
3) Mask - you're going to need various sizes and nasal canulas also. Again stuff with a shelf life
4) Paperwork - you're going to need to keep records of when and where the cylinder was filled, and all testing performed on the cylinder.
5) Storage - where do you plan on keeping this cylinder, and how are you going to ensure that it remains relatively clean and secure?

 

[ffemt8978]

that definitely sparked my interest and will do more research...

My point was that just because the military does it one way does not mean it's applicable outside of the military. IIRC, we have to empty a cylinder when it's test date comes up