mycrofft
Still crazy but elsewhere
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- 48
Ventmedic, I agree, and I disagree.
"The Bends"...it depends upon the severity. I said it was better than nothing, but until those gas bubbles causing circulatory occlusion are physically out of there, the damage continues. Non-hyperbaric O2 at mean sea level pressures can help by increasing the possibility of O2 perfusion of a gas embolized area via collateral circulation etc, but if the gas embolism gets bad enough there's going to be an infarct if primary circ is not reestablished, and nonhyperbaric
O2 simply cannot do it in time if at all in serious cases. If it could, the U.S. Navy would just put their "bent" divers on O2 instead of jetting them to recompression/decompression centers.
The DAN study is not a scientific statistically controlled or double blind study but an empiric observation, no control group or accomodation for the confounders of false diagnoses and the number of bent folks who each year spontaneously reabsorb and recover. Despite that, I agree that O2 still ought to be administered as it is the best/only measure until proper recompression then decompression are achieved for the more serious cases.
(When I was at Travis AFB's David Grant Medical Center I cared for a non-bends hyperbaric pt. Different gas mixes were administered to people via mask while sitting in a hyperbaric overall environment, quite large, more of a "parlor" than a "tank").
Hyperoxia in the field is pretty rare, versus hyperventilation, which in the field is not too rare. In either event, whether it is the primary diagnosis or not, you displace CO2, which raises pH and makes haemoglobin less able to swap O2 for CO2, causing the S/S in the field, and the tx is the same: less O2.
As for "knowing the cause of the hypeventilation", I agree, but I might use the phrase "knowing how to differentiate between hyperventilation and struggling to get enough air"; as you are getting the pt to the hospital, you are assessing them, and some O2 won't kill either and will help the person who is suffocating. (I don't ever use the clasic brown paper bag, I have hyperventilators breathe through their t-shirt and answer a barrage of questions which forces them to stop long enough to talk, then breath warm humidified rebreathed air; if they get worse or resist, I switch to O2). Theoretically, the gold standard would be field ABG's, but in the field and on the way to defintive care, treat the clinical signs and symptoms, keep 'em alive, but get 'em in.
The stunt with the O2 mask...I was trying to be ironic, when I've seen it work it was accidental and the mask was on (but not the oxygen) for about fifteen seconds. I once picked up a pt from a nursing home, they hoped to get the pt out before she died, to keep their statistics looking good. Amazing how she perked up when we turned her mask O2 from 2 LPM to 8 for a while!
My apology. From now on when I'm wisecracking or being ironic, I'll try to remember to use an emoticon, I forget some folks will take it seriously because they are new to it, etc.
"The Bends"...it depends upon the severity. I said it was better than nothing, but until those gas bubbles causing circulatory occlusion are physically out of there, the damage continues. Non-hyperbaric O2 at mean sea level pressures can help by increasing the possibility of O2 perfusion of a gas embolized area via collateral circulation etc, but if the gas embolism gets bad enough there's going to be an infarct if primary circ is not reestablished, and nonhyperbaric
O2 simply cannot do it in time if at all in serious cases. If it could, the U.S. Navy would just put their "bent" divers on O2 instead of jetting them to recompression/decompression centers.
The DAN study is not a scientific statistically controlled or double blind study but an empiric observation, no control group or accomodation for the confounders of false diagnoses and the number of bent folks who each year spontaneously reabsorb and recover. Despite that, I agree that O2 still ought to be administered as it is the best/only measure until proper recompression then decompression are achieved for the more serious cases.
(When I was at Travis AFB's David Grant Medical Center I cared for a non-bends hyperbaric pt. Different gas mixes were administered to people via mask while sitting in a hyperbaric overall environment, quite large, more of a "parlor" than a "tank").
Hyperoxia in the field is pretty rare, versus hyperventilation, which in the field is not too rare. In either event, whether it is the primary diagnosis or not, you displace CO2, which raises pH and makes haemoglobin less able to swap O2 for CO2, causing the S/S in the field, and the tx is the same: less O2.
As for "knowing the cause of the hypeventilation", I agree, but I might use the phrase "knowing how to differentiate between hyperventilation and struggling to get enough air"; as you are getting the pt to the hospital, you are assessing them, and some O2 won't kill either and will help the person who is suffocating. (I don't ever use the clasic brown paper bag, I have hyperventilators breathe through their t-shirt and answer a barrage of questions which forces them to stop long enough to talk, then breath warm humidified rebreathed air; if they get worse or resist, I switch to O2). Theoretically, the gold standard would be field ABG's, but in the field and on the way to defintive care, treat the clinical signs and symptoms, keep 'em alive, but get 'em in.
The stunt with the O2 mask...I was trying to be ironic, when I've seen it work it was accidental and the mask was on (but not the oxygen) for about fifteen seconds. I once picked up a pt from a nursing home, they hoped to get the pt out before she died, to keep their statistics looking good. Amazing how she perked up when we turned her mask O2 from 2 LPM to 8 for a while!
My apology. From now on when I'm wisecracking or being ironic, I'll try to remember to use an emoticon, I forget some folks will take it seriously because they are new to it, etc.
