Gas toxicity

[madmole]

Thanks, I've obviously got some research and reading to do now.

As for being a lowly GP, well paramedics need to know a lot less theory about far fewer things than you guys. We are the do'ers instead. We both have areas we are good at. I'll take a dead volvo upside down in a flooded ditch anyday over a screaming brat with chicken pox. (funnily enough its ALWAYS a volvo in the ditch!!!)

Thanks for your help and patience

 

[The Iceni]

Madmole,

Not really a diving matter but you did say" In fact about the only people crews habitually will ignore are GP's and nurses who seem to appear like magic at incidents and proceed to tell you how to do your job."

I am very much a hands-on sort of guy. One thing that distresses me is the number of times local crews do ignore me and "stay and play" after I have exerted considerable effort stabilising my patients. I realise they have to follow protocols but if they are prepared to ignore a doctor, what hope does a diver rescuer have?

The one thing doctors hate is time wasters, such as little Jimmy with a rash and a temperature at 6 pm after dad gets home. After all it must be meningitis, mum is convinced he is photophobic, he has a stiff neck and the "glass tumbler test" is positive! (Now there's a useful clinical sign if ever there was one!)

Ah well, C'est la vie!

Kind regards.

 

[madmole]

Agree whole heartedly on that one

When I first crewed an ambulance some 18 years ago, we were the pick em up and rush em to A&E brigade. We did enough to keep em alive on route, and it worked well

Now we have drips and de-fibs and I see some crews spend 40 mins on the pavement zapping and playing!!!!. Well I'm a trainer assesor and they wont pass my assesments. The place to play at doctors is in the back of the vehicle on rapid route to A&E where the real expertise is.

Funny thing is the modern techniques dont seem to have a better survival rate to my mind.

My worse one so far was a 999 call for a spot on the forehead, that had burst. Unfortunately as an Ambulance is NOT legally an emergency service (we dont look after property) we couldn't get him arrested for time wasting. Bet you wished you could do that to a few of your patients

 

[Dr Deco]

Dear madmole and Dr Thomas:

This certainly was a busy thread when I finally had time to look at it. Here are a couple of comments – if anyone is still left.

[1.] Carbon dioxide does indeed contribute to the gas in decompression bubbles, but its concentration is generally very low in comparison to nitrogen (or helium). In diving, carbon dioxide partial pressure in the tissues is quite trivial. In altitude depressurizations, however, CO2 can play a very large role since all gases have relatively small partial pressures.

During WWII, one explanation for exercise-induced DCS was referred to as the “work theory.” Here, musculoskeletal work increased the concentration of carbon dioxide, contributed gas to bubble growth, and increased the incidence of DCS.

This theory was countered by the “strain theory” of E. N. Harvey. According to this concept, musculoskeletal activity generated low-pressure regions within the tissues and generated micronuclei. This concept is in use today by many barophysiologists (but certainly not by all).

[2.] Nitrous oxide will most certainly cause laboratory animals with incipient (sub clinical DCS) to develop more severe problems of decompression sickness. I have not heard of an instance where nitrous oxide has effected an exacerbation of DCS in humans. It is certainly a possibility, however.

[3.] Xenon could be used as a decompression gas with respect to its slower uptake than nitrogen. I would suspect that it is of no real value since it is an anesthetic at atmospheric pressure. Decompression could be accelerated on the surface more by breathing oxygen and some kinetic activity (to increase blood flow).

Dr Deco

:doctor: