Oxygen Administration Skills- Did I miss something (like demand valves comin' back?)

[medic_diver45]

Hello,

Been reading with interest the different attitudes and opinions
Like yourself i work daily with 02 provision and have used various methods in treatment of stable to unstable patients plus had o2 for countless ressus attempts particulary with drownings.all outside of a hospital setting

Im a qualified Cht, Dmt, alst, and have succesfully treated over 90 dcs cases having stabalised before evacuating to multiplace chamber.

Im also an instructor For tech diving and an instructor trainer for Dan.

I feel that some people here are takeing your stand on things as you trying to preach and prove that ye know more than most.

I simply see it that you are thinking outside the box.

Unfourtunatly as you know these international protocolls (ie demand is better)are always based on evidence based research and are deemed unarguable.
However im sure you will agree that change often takes time and the current stay of play is not always correct.

I personally introduce the MTV 100 in courses pointing out the dangers associated I also point out that in most cases Nrb is what the patient will accept and end up with.

AS you correctly state an injured patient particulary from barotrauma will find it easier to breath from an nrb.
most dcs patients are also very anxious and require the same.

Its important for people to use common sense with dive accidents to not go beyond there level of training and most importantly to not be scared to provide 02 in a dive accident.

Kind regards

Gary

I agree with your points for the most part:
1. I am not trying to preach, I am just questioning why things are done a certain way. I don't think I am smarter than anyone else (unless that person's actions or statements prove they are about as sharp as a sack of wet mice), just that I know a lot about O2 systems, and more than the average Joe out there because of my background. There are probably lots of people on this board who are smarter than I, especially when it comes to the hyperbaric aspects of medicine (i.e. once they hit the chamber, I'm like Ray Charles in the Louvre....I haven't got a f-----' clue!)

2. No one should be afraid to give O2 to a patient who needs it. It won't hurt and it might well do some good.

3. People who are short of breath, no matter their previous fears, almost always become severely claustrophobic about things being on their face.

The one thing I do take issue with is "international protocols" being unarguable.....Well, there's a couple of problems with that....one I can argue anything I want, won't necessarily win, but I can try. I am arguing (not on here so much anymore) but in an article that I am writing for a trade magazine that placing a MTV-100 pressure resuscitator in the hands of what would be viewed by most as a layperson is not in keeping with the best practice when much less risky and far more cost effective alternatives to ventilate apneic patients exist. If the true goal is to do the greatest good for the greatest number, shouldn't the idea be to keep the cost of the kit as low as possible so more people can afford one and keep the safest most basic equipment to do the job in the kit? That is all I am saying.

By the way, change doesn't always take time- it can happen real fast after a multi-million dollar lawsuit. That's just food for thought....


Two- what happens if I or another medical professional (who is trained under a different set of protocols- also nationally and internationally recognized) is responsible for taking care of a patient? What protocols do I follow? I can tell you that if I were to follow the DAN protocol and use a demand valve on a patient right now here where I am at my fire department medical director (a very large very grumpy man) would have my license pulled before you can say "VIOLATED LOCAL PROTOCOL" (after he chewed my a-- thoroughly just because he can and he gets almost orgasmic pleasure from watching people squirm)

It wouldn't matter whether or not I was technically representing the fire department or not, I still wouldn't have a leg to stand on as the state views demand valves as outside of the scope of practice of an EMS provider (you should see what they say about MTV-100; it's listed as an unsafe medical device (or so I was told by an acquaintance of mine who at the time was a member of the state EMS commission) and is not allowed on ambulances).

 

[HammerNoMore]

JAMES, I appreciate the insight into how divers normally react after taking a hit- as I have only seen one diving injury in my medical career (and that was an air embolism- the guy was freaking, as I would be) I do not have a wide base of experience to base a guess on.

That's certainly going to happen occationally. But you'll find tons of reasearch material available here. I can think of at least 3 or 4 threads where one of our members took a hit within the past year. More often than not, they don't even realize they've been hit until hours later. In one case, the user got online and asked about his symptoms. It was some of our medical mods who convinced him to go see the doctor.

James

 

[Brian1968]

Time to chime in with my 2 psi.

If I'm bent (touch wood it never happens) and I'm on a finite supply of O2 and with an appreciable transport time to a hospital I'll take the demand valve, thanks. It will meet my flow demands better than an NRB and I want that tank lasting as long it can.

Brian, RRT (since the dinosaurs I think)

 

[bridgediver]

This thread is all over the place! I think the real question was positive pressure for DCS or constant flow right?

Stephen, I have to ask if you guys use entonox on your ambulance because its virtually the same set up as the positive pressure devices used for delivering O2 for DCS emergencies? As many have stated NRB's won't provide as high O2 as pos pres. and will waste your gas supply. I've never heard of entonox being administered by a NRB and I would suggest that this is the same reason.

Have you taken any of DAN's O2 provider courses? Can you speculate on a class that you have not taken?

I'll try to put this as gently as I can. You seem to have convinced at least one person that the accepted method (positive pressure) is wrong. All these posts about the physiology and mechanics is just going to confuse the average reader on this board. Your logic is flawed and I hope most can see through that because you are making yourself out to be an expert in a field that you don't know much about.

Many would still consider you a newbie, at least as an RT. Sorry.

Jim

ditto

I don't want to get into a pi**ing match with you but I have at least equal training as you and have been doing it for far longer.

Sorry if I have come off strongly but the impressions your posts have made on me are strong and I'm responding in kind.

 

[TheAvatar]

This thread is all over the place! I think the real question was positive pressure for DCS or constant flow right?

I think you misunderstand the argument.
The argument is about TWO demand types:

The MTV-100 oxygen powered ventilator (aka manually triggered demand valve) for apneic patients (or those with insufficent respiration)
The argument revovles around why DAN is teaching lay persons to use this device which is regarded by most of the medical community as dangerous even in the hands of EMTs when a BVM is a safer, more reliable, (more) legal, and just as effective adjunct.

The standard DAN demand mask for breathing patients (not really positive pressure)
The argument revolves around whether it delivers higher percentage O2 and whether it actually more efficient in oxygen use and more effective in oxygen use versus a NRB. (This demand mask doesn't appear to have anything that gives it a tighter seal than a NRB, but I think say it is more efficient in O2 use some cases).

------------------------------

I spoke with a RN (EM) and a MD (Aerospace (hyper and hypobaric) Medicine, also MPH and trained for emergency med) about the MTV-100 and they both said that a MTV-100 was a dangerous tool for a lay person to be using when a BVM was available.

They also said that a lawyer would have a hayday suing the pants off any MTV case where there were complications. Watch as DAN, threatened with liability, says, "We trained him how to use it. We didn't give him the authority to use it" and throws Joe AdvO2 to the sharks (lawyers).

Further, as medicdiver stated, an EMT would be stripped of his certification for using such a device if their state didn't allow it, AdvO2 cert or not.

Another Advantage to the BVM: when you run out of O2, you just keep ventilating on room air, you don't have to rip off the mask and find your BVM like when using an MTV-100.

It appears the DAN protocols are behind the times.

 

[gazzahawkes]

Hi

My point was evidence based reseach Drs on medical boards do take time to establish new protocol.Like lemmings one has to take the jump first then the rest follow.at international level.

As for the Mtv and training people. i see it more as awareness and further knowledge.no one should be given 4hrs training then let loose on there first emergency they stumble across.
at least by being aware this can be stopped.

Take Guns Truly dangerous yet many people are trained doesnt mean they will shoot some one.

Cool bannanas
:11ztongue