Type of poisoning where giving O2 is instanty fatal

[JPINFV]

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."

 

[JPINFV]

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.

 

[tickle me doe face]

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.

That makes sense...

is molecular oxygen a radical?

 

[Cup of Joe]

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."

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."

 

[medichopeful]

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.

 

[usalsfyre]

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.

 

[tickle me doe face]

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?

 

[JPINFV]

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.

 

[JPINFV]

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?

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.

 

[tickle me doe face]

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?

 

[JPINFV]

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...

 

[usalsfyre]

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.

 

[tickle me doe face]

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

 

[JPINFV]

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.

 

[Shishkabob]

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'.

 

[JPINFV]

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.

 

[usalsfyre]

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?

 

[JPINFV]

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...

 

[JPINFV]

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.

 

[usalsfyre]

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.