Emergency O2-- decisions, decisions

[rongoodman]

Given the difficulty of maintaining a good mask seal with a BVM even by trained rescuers, I would think the best solution would be the pocket mask with the supplemental O2 inlet. If you're thinking about O2 administration you probably will have a pocket mask already.

 

[Hoyden]

I recently completed DAN's Advanced Oxygen First Aid for Scuba Divers and will be getting a MTV-100 as soon as I can come up with the extra money. In the mean time I carry a Bag valve mask with my O2 kit. For our purposes as divers, I can't imagine a better tool than the MTV 100 (or any flow restricted oxygen powered ventilator) for a non-breathing diver. For our purposes as divers, we want to deliver the highest possible concentration of O2 in a way that is easiest to sustain over time and conserves our O2 supply - say on a 40 minute boat ride or a wait for a helicopter off-shore. Even for a 15-minute wait for the ambulance at a local quarry, a manually triggered ventilator could mean a significant increase in survival chances. These are different needs than the local ambulance crew has. There is no need to use this tool (at least the manual trigger) on a conscious, breathing patient so the objections to that are meaningless. That patient can use the MTV 100 as a demand valve or use a non-rebreather mask. The MTV 100 can deliver a flow of greater than 40 lpm to a breathing injured diver, but when it is used for a non-breathing injured diver the flow is automatically reduced to 40 lpm, thereby reducing the risks (gas introduction to the stomach and lung pressure injuries) associated with earlier oxygen powered ventilators. Keep in mind that we are talking about non-breathing divers - a little air in the stomach or a possible lung injury kind of pale next to the non-breathing, brain cell death kind of thing. Get the training, learn to use the tool safely and have one with you. It is a valuable tool for dive rescue, at least according to DAN and I will take their recommendations over the local EMTs any time - nothing personal with regard to the local EMTs, but diving injury/rescue/resuscitation is not their field of expertise.

YMMV,

Jackie

 

[fire_diver]

You are so completely wrong that it's trully frightening.

For the overwhelming majority of patients treated this may be true. However, a non-rebreather does not provide 100% O2 which can be achieved with a demand mask. Also, a constant flow setup like a nonrebreather is very wasteful. If you expect a long time before handing the patient off to EMS you might be concerned with conserving your oxygen supply.

Yes, a non-rebreather DOES provide 100% O2 if you are using it correctly, and you are using the correct model for this application. Are you somehow thinking about the mask used to give albuterol breathing treatments?

Constant flow is EXACTLY what you need if the patient is unresponsive but breathing.
Use your O2 in the best possible manner until it runs out. Don't ration it and prevent or delay recovery.

They will also show you the oxygen bottle they have in their unit which is significantly large than anything you'd consider taking diving.

Really? I'm an EMT and I carry the exact same bottle we use at work, on my boat. It's about the same size as an 13cf pony.

Divers have needs which your normal EMS units don't have to consider so I wouldn't be so quick to dismiss the use of demand valves.

You need to just "not talk" if you don't know what you're talking about!

A diver giving care to another injured/bent diver is in no way even CLOSE to "what EMS units have to consider"

My department carries but doesn't use demand valve regulator because they CAN AND WILL cause injury. They are only still on our trucks because the chiefs are too set in their old ways to remove them.

A BVM delivers the right amount of air EVERYTIME when you are trained to use it.

FD

 

[fire_diver]

Keep in mind that we are talking about non-breathing divers - a little air in the stomach or a possible lung injury kind of pale next to the non-breathing, brain cell death kind of thing.

WRONG! When air gets pushed into the stomach it has to go somewhere. Where would that be? Right back out the way it went in. Along with undigested food and stomach acid. Which would then also go right into lungs. You just made a bad situation much worse.

Do you know what happens when you over-inflate the lungs? I guess not. The resulting trauma causes lungs to begin to fill with fluid. Then you can't put ANY O2 in there to help this guy. And you probably just ensured his death. Congrats!

Get the training, learn to use the tool safely and have one with you. It is a valuable tool for dive rescue, at least according to DAN and I will take their recommendations over the local EMTs any time - nothing personal with regard to the local EMTs, but diving injury/rescue/resuscitation is not their field of expertise.

Take your own advice get training, REAL training. DAN over a practicing, working EMT? Man I would hate to be in your family. You obviously have no clue what an EMT is trained to do.

FD

 

[knotical]

At the risk of sounding like a DAN apologist, or further offending EMTs, who I hold in high regard, technology evolves.

The MTV-100 meets current AHA CPR guidelines. The MTV-100 limits pressure to 60 cmH20, reducing the risks cited by others. It delivers 40 liters per minute during the manually-triggered breath.

When the MTV-100 is used passively, it is a demand valve. Demand valves can an excellent choice for the breathing diver who is suspected of suffering from DCI.

The MTV-100, demand valves, constant flow devices, bag valves masks and others are just tools, and can be used or mis-used.

 

[rongoodman]

The flow-regulated device sounds like it's in compliance with current standards. I'm not convinced it's cost-effective for an individual kit. I'm assuming the cheaper DAN kit contains a demand-valve set-up, but does not provide postive pressure.

 

[Wildcard]

I can't believe it's even legal to sell demand valves to lay people. There are so many problems with them there use in EMS and in the hospital is virtualy nonexistant. I have a pile of them in the barn given to me by the hospital when they pulled all of them from use, due to the afore mentioned problems.
Anyone that is arguing for demand valves clearly has no real world experence with them. Stick with a BVM or a rebreather PRN. BTW, you will be taught that NRBs need 15 LPM or higher but in reality flows as low as 6-8 LPM will still flow near 100% with a good seal.

 

[HowieDean]

I really hope that you guys feel comfortable with your 2 day O2 class.
It really speaks mounds about your intelligence when you think you know more then people who did this stuff every day.......

I hope you will take some simple FACTS to heart....

The chances of you being the HERO and saving a near death patient are very slim...
CPR doesn't save very many people
AED's don't save very many people

So here is the catch 22

The chances of you causing serious permenet damage to a slightly compromised individual with a positive pressure ventilator are hundreds of time greater then you bringing somebody back to life....

I don't care if you are a Doctor - EMT - Nurse - Paramedic or a FIRST AIDer..
The number ONE rule is DO NO HARM.............

 

[knotical]

I'm assuming the cheaper DAN kit contains a demand-valve set-up, but does not provide postive pressure.

Correct, demand or constant flow. It's similar to the MTV without the red button.

 

[Wildcard]

Like I said, I can't believe it's legal........
What is also disturbing is the total lack of discusion about maintaining a patent airway. Mask, NRB, BVM or demand valve, all still require that you maintain an airway and I'll tell you what folks, it aint easy!