9 replies to this topic

[captsteve]

I would like to refer those interested to an alert posted by Duke Medical on scubaboard concerning use of o2 for dive accidents. you will find the post under diving accidents and headlining "surface oxygen and the risk of o2 toxicity"
Thanks,
Captsteve

[ev780]

Interesting discussion.

As a side note there is a growing body of evidence in EMS that the indiscriminate use of oxygen in a patient who has a normal blood oxygen content MAY do more harm than good. The studies are limited to cardiac and neurological emergencies and are very very preliminary, but it is interesting fodder among emergency docs, paramedics, and ED nurses. It will be very interesting to see how this all transitions into the dive industry in the coming years. Screaming oxygen, oxygen oxygen may not be the future treatment of suspected DCS. The body is remarkable and healing itself and the more we learn the more we let the body do its thing.

[Scubatooth]

Interesting discussion.

As a side note there is a growing body of evidence in EMS that the indiscriminate use of oxygen in a patient who has a normal blood oxygen content MAY do more harm than good. The studies are limited to cardiac and neurological emergencies and are very very preliminary, but it is interesting fodder among emergency docs, paramedics, and ED nurses. It will be very interesting to see how this all transitions into the dive industry in the coming years. Screaming oxygen, oxygen oxygen may not be the future treatment of suspected DCS. The body is remarkable and healing itself and the more we learn the more we let the body do its thing.

Ill second this, between this and the American Heart guidelines for CPR there may be lots of changes coming down the pipe. Been doing lots of reading lately and this has been the bulk of things.

The OxTox risk has been there forever as even the CNS clock runs on 100% oxygen. From doing inter-facility (Hospital/ICU to Hospital/ICU) I have transported patients whose CNS and OTU clocks and units were beyond safe ranges, and were either seizure risks with anti seizure medications running or did end up having seizures during transport because of the oxygen use/exposure. **added 15:15 10/31/2010 -- Note these examples are not normal persons, but persons on ventilators and in less then fair condition/stable.

Ev780 you read JEMS or JEMSconnect online?

Edited by Scubatooth, 31 October 2010 - 02:23 PM.

[ev780]

Interesting discussion.

As a side note there is a growing body of evidence in EMS that the indiscriminate use of oxygen in a patient who has a normal blood oxygen content MAY do more harm than good. The studies are limited to cardiac and neurological emergencies and are very very preliminary, but it is interesting fodder among emergency docs, paramedics, and ED nurses. It will be very interesting to see how this all transitions into the dive industry in the coming years. Screaming oxygen, oxygen oxygen may not be the future treatment of suspected DCS. The body is remarkable and healing itself and the more we learn the more we let the body do its thing.

Ill second this, between this and the American Heart guidelines for CPR there may be lots of changes coming down the pipe. Been doing lots of reading lately and this has been the bulk of things.

The OxTox risk has been there forever as even the CNS clock runs on 100% oxygen. From doing inter-facility (Hospital/ICU to Hospital/ICU) I have transported patients whose CNS and OTU clocks and units were beyond safe ranges, and were either seizure risks with anti seizure medications running or did end up having seizures during transport because of the oxygen use/exposure.

Ev780 you read JEMS or JEMSconnect online?

I do when I have time. More administration these days but do my best to stay current onthe medicine.

Fred

[Scubatooth]

Was just wondering thats all. I was given copies of the o2 papers, and AHA by one of our educators at work since i have been off for back surgery.

The changes in oxygen use in our system have been in place for over a year as our protocol is to titrate oxygen delivery based on oxygen saturation's, the history, and presentation of the situation.

Steve do you have i direct link for the thread im not seeing one on SB. I do know there is a discussion thread on facebook one the duke dive medicine page.

[captsteve]

Having seen a fair amount of diving emergencies and having seen the consequences of refusing o2, I have a hard time not completely agreeing with Duke medicals warning and have put up this thread to help awareness. It is next to impossable to help someone that self diagnoses and difficult enough to treat someone who is combative from DCS. The risks of surface o2 is minimal when posed with longterm harm caused by many variations of DCS without the mitigating treatment of o2. There is little any crew of a diving operation can do beyond very simple proceedures such as cpr, administering o2 etc which just improve chances for a dive accident victim until they can receive proper medical treatment and diagnosis.
I do not have the direct link, but it is under the dive accident section on SB.

[captsteve]

Interesting discussion.

As a side note there is a growing body of evidence in EMS that the indiscriminate use of oxygen in a patient who has a normal blood oxygen content MAY do more harm than good. The studies are limited to cardiac and neurological emergencies and are very very preliminary, but it is interesting fodder among emergency docs, paramedics, and ED nurses. It will be very interesting to see how this all transitions into the dive industry in the coming years. Screaming oxygen, oxygen oxygen may not be the future treatment of suspected DCS. The body is remarkable and healing itself and the more we learn the more we let the body do its thing.

Ill second this, between this and the American Heart guidelines for CPR there may be lots of changes coming down the pipe. Been doing lots of reading lately and this has been the bulk of things.

The OxTox risk has been there forever as even the CNS clock runs on 100% oxygen. From doing inter-facility (Hospital/ICU to Hospital/ICU) I have transported patients whose CNS and OTU clocks and units were beyond safe ranges, and were either seizure risks with anti seizure medications running or did end up having seizures during transport because of the oxygen use/exposure. **added 15:15 10/31/2010 -- Note these examples are not normal persons, but persons on ventilators and in less then fair condition/stable.

Ev780 you read JEMS or JEMSconnect online?

I am not a doctor or medical professional, so excuse any of my ignorance in this matter. The primary circumstance results in the end treatment requiring recompression with o2, so the argument here is in the intemediate treatment with the possibility of seizure on the surface being less that the increased risks associated with non treatment during the intermediate.

[Scubatooth]

what ev780 and I have mentioned is related to dry land EMS, scene and inter-facility transport and treatment with the use of oxygen.


For the longest time in EMS oxygen was given for just about everything at high flow rates 2-15+ liters per minute, it was a catch all and in some cases could be called a placebo move/effect. Dive related injuries are another matter where you have other items playing into things. Remember even at the surface a diver breathing pure oxygen is still getting a PPo2 of 1.0 (the fraction actually inspired may be a different). New research is stating that this is not such a good idea (certain cases of COPD) and may cause more harm then good..

when it comes to recompression the biggest focus is reducing the size of the bubbles so that the body can get rid of it(through normal respiration), this is where oxygen under higher pressure can help. If a persons normal blood oxygen saturations are in the 96-100% range (which is typical saturation rates for average adult) supplemental oxygen is not going to do much good (there's a couple of other possibilities)on the surface.

[ev780]

what ev780 and I have mentioned is related to dry land EMS, scene and inter-facility transport and treatment with the use of oxygen.


For the longest time in EMS oxygen was given for just about everything at high flow rates 2-15+ liters per minute, it was a catch all and in some cases could be called a placebo move/effect. Dive related injuries are another matter where you have other items playing into things. Remember even at the surface a diver breathing pure oxygen is still getting a PPo2 of 1.0 (the fraction actually inspired may be a different). New research is stating that this is not such a good idea (certain cases of COPD) and may cause more harm then good..

when it comes to recompression the biggest focus is reducing the size of the bubbles so that the body can get rid of it(through normal respiration), this is where oxygen under higher pressure can help. If a persons normal blood oxygen saturations are in the 96-100% range (which is typical saturation rates for average adult) supplemental oxygen is not going to do much good (there's a couple of other possibilities)on the surface.

Well stated. Also, I was using it as an example of how research is driving and changing medicine, sometimes radically. I was just opining if the new theories on oxygen use generally, will bear out in the dive medicine arena over time.


Please, everyone, do not change anything you have been taught!! Yet!!! O2 for any suspected DCS event is still the standard of care. But IMHO it will evolve in the coming years as we study the effects of the once "benign" drug known as oxygen.

Fred

[Scubatooth]

Please, everyone, do not change anything you have been taught!! Yet!!! O2 for any suspected DCS event is still the standard of care. But IMHO it will evolve in the coming years as we study the effects of the once "benign" drug known as oxygen.

Fred

Ill Second that. Right now the giving o2 to a diver with suspected DCS is still the standard, until you hear DAN making recommendations or changes to its courses don't change anything. When it happens it will be just like CPR changes they will be broadcast far and wide.

Steve - I have dug through SB and didnt see it. If the info you are talking about is similar to what is on Duke Dive Medicines Facebook page then I have seen it.