Would you accept O2 without qualification?

[GoBlue!]

Other than a fire on board, I can't think of any real contraindications to giving oxygen if needed. I can't think of a "cardiac condition" that would be significantly worsened by oxygen administration, and the data behind withholding oxygen from acute stroke victims is poor at best. There was a quasi-randomized Norwegian study (Stroke 1999; 30:2033-2037) that I just found that looked at supplemental O2 in nonhypoxic patients for the 1st 24 hrs of hospitalization. Basically, it found no mortality benefit (75% power to detect 10% difference at p=0.05 for those of you who care) to oxygen administration in this nonhypoxic population, but no definite harm either. They did some subgroup analyses that suggested possible harm in certain groups, but I don't even want to discuss it further because I thought this part of the study was garbage.

Even if you were to believe this single, weak study, however, it is definitely in no way generalizable to a dive accident victim with stroke symptoms. I'd be MUCH more worried that a diver with stroke symptoms was suffering from AGE, which calls for emergent oxygen treatment, than a thrombotic or hemorrhagic stroke (which the study population suffered from).

Dive boats don't have pulse oximeters, nor do they need them, in my opinion. No need to only give oxygen to the hypoxic diver. Give it to any w/ symptoms suspicious of DCI.

One comment to the post re: nitrous oxide. Not that it should be used in divers, but nitrogen gas (N2) & nitrous oxide (NO2) are two different things. I don't think nitrous oxide, in theory, would make a bent diver worse (at least from the "nitrogen" content). Willing to be corrected, as always, if anyone knows differently.

Jim

 

[Knavey]

The defib at work is a no brainer.

Put the pads on the chest and stand back.

If the machine detects a heartbeat, it will not fire. If it determines that the heart has stopped, it will fire.

It gives audio instructions for every step of the process.

Simple as that.

 

[Wildcard]

I rember when the "free oxygen radical" debate came out and some questioned high flow use of 02. It, like most of the porly done studies was dismised as just that. Flow to Ozzzzz, you won't be sued.

As far as the article about Auto defibs saving as many people as Paramedics, Auto defibs are the first step in a long chain of events including promt ACLS. You don't just plug the patient in and they go on there way.

And finaly, a comment about the fires. I transported TWO people in two weeks for trying to light a ciggarette while on nasal cannula oxygen. Plastic, pure 02 and fire, hummm? Guess what happened?

 

[lamont]

One comment to the post re: nitrous oxide. Not that it should be used in divers, but nitrogen gas (N2) & nitrous oxide (NO2) are two different things. I don't think nitrous oxide, in theory, would make a bent diver worse (at least from the "nitrogen" content). Willing to be corrected, as always, if anyone knows differently.

Jim

NO2 is another inert gas. Its pretty much just like giving 50% O2/50% N2. Better than 21% O2, but not as good as 100%.

 

[MikeFerrara]

What if you were bent and in too much pain to do it for yourself, yet aware enough to realize what was happening?

Then put the stupid mask on my face please.

If I'm unconcious please any one with the mechanical sense to turn the valve on...put the mask on my face.

Give me O2...lots of O2.

 

[Seabear70]

NO2 is another inert gas. Its pretty much just like giving 50% O2/50% N2. Better than 21% O2, but not as good as 100%.

Off topic a bit, but...

I've never understood why N2 and NO2 were considered inert. I realize they are not metabilized, at least I do not think they are, but both have a significant and measurable effect on the body.

 

[GoBlue!]

NO2 is another inert gas. Its pretty much just like giving 50% O2/50% N2. Better than 21% O2, but not as good as 100%.

Hmmm... Not sure I agree that 50% O2/50% N2 is the same as 50% O2/50% NO2. N2 will diffuse down its pressure gradient, which will be greater if the inspired gas does not contain nitrogen. Nitrous oxide would not change the N2 gradient.

Now, if nitrous oxide has other properties that would inhibit offgassing, I'd buy it. I seem to remember from the days when I was interested in anesthesia that nitrous oxide does have interesting properties that I'm not recalling....

Perhaps this topic could be brought up in Dr Deco's forum.

Jim

 

[GoBlue!]

I rember when the "free oxygen radical" debate came out and some questioned high flow use of 02. It, like most of the porly done studies was dismised as just that. Flow to Ozzzzz, you won't be sued.

Effects of free radicals at the cellular level are far from being understood. There is a LOT of active research going on in the area; far from "dismissed." Bottom line for now, however, is that oxygen should not be withheld in the scenarios we're discussing!

Jim

 

[Wildcard]

Dredging back to chemestry here, Isn't Nitrogen an element and NO2 a compound? I don't ever rember hearing anything about no NO2. That's it's beauty, no SOB, No contraindications.

 

[Allison Finch]

I should add a rider to my first post above.
For the purposes of this poll, I assume we are talking about divers that have been medically cleared to dive.
As far as I know, oxygen has only been found to worsen certain medical conditions such as strokes and other cardiac related problems. These people shouldn't be diving.

About the only condition that could suffer with O2 is COPD. I really don't see anyone with chronic COPD diving anywhere.