Is oxygen a medicine?

[TwoBitTxn]

David,

I think the skipper needs to take all the factors into account, weigh appropriately, and act appropriately. There were times as an EMT we would try to treat someone who flatly refused treatment. There is nothing that can be done. Once a person goes unconsious consent to treat is implied. You try to convince someone to be treated if there is a possibility they need it.

I can't/won't state my opinions on Pos-tech original post.

TwoBit

 

[Cherry]

At what times should you "not" administer O2? During our Occupational First Aid Level 2 course I do not remember and instance where O2 was a risk factor. O2 is a firstaid treat ment but it is not that O2 is considered a drug (FA's can't administer ANY drugs but we can administer O2) but that the procedure requires training. But just for information here is what our manuals say about indications for Oxygen use;

1. Respiratory and or cardiac arrest
2. All trauma vicitms in the Rapid transport catagory
3. Shortness of breath acute or chronic
4. shock
5. Cardiovascular or respiratory illness
6. Inadequate respiration ( eg drug overdose)
7. Decreased levels of consiousness
8. Pregnant patients
9. All medical evac patients
10. All paitients with decompression illness

That is right out of our BC Training manual. so if anyone is even slightly supect of #10 and in my care they are getting O2. It seems that many diving related concerns are covered in at least 9 and if you are a pregnant female all 10 instances. So back to the question....No, oxygen is not a medicine but the administration of Oxygen is a medical procedure.

 

[The Iceni]

Cherry once bubbled...
. . . .No, oxygen is not a medicine but the administration of Oxygen is a medical procedure.

Hi Cherry, You have confirmed the problem, as I see it.

From the point of view of a first responder you are absolutely correct but this assumes a medical "incident" has occurred.

I will not labour the point, but it would seem you do not believe I should be entitled to use oxygen on the surface following any dive as an integral part of my decompression schedule solely because its "administration is a medical procedure" and therefore I should only use it on the surface when there is immediate and obvious evidence of DCI.

Forgetting semantics and the law for a minute, can I ask you to look in detail at the physical and physiological mechanisms employed in accelerated decompression, where rich Nitrox mixes are employed to accelerate the offgassing of Nitrogen, (by increasing the nitrogen offgassing pressure by 0.79 bar on the surface) and explain for the benefit of myself and other scubaboarders, how you arrived at your decision? Bare in mind it can take quite a few minutes for the symptoms of neurological DCI to develop.

I had originally intended to write a post along the lines of Genesis' latest but felt that would constitute a "lecture" and therefore would be ignored but he is absolutely correct.

I believe posting this poll has at least got scubaboarders thinking about this very odd situation. There are very few genuine contraindications to oxygen administration. Divers, as a group, will not fall into any of those diagnostic categories. For example a patient with advanced COPD and who relies on the pp of oxygen for their respiratory drive, such as those with emphysema, will be medically unfit to dive in the first place.

Perhaps this subject is something DAN should be asked to look into? :doctor:

 

[Alban]

Hello all
I will offer my view as a diving officer within a club. I am personally responsible for the safety of all divers and I would be the one that gets sued. I do agree that denial is a big problem and this leads to delay in treatment mostly because of peer pressure.
I think in recent years the use of 100 % O2 as a decompression gas has gained popularity and inevitably more divers have this available to them after a dive and it is easy to carry on breathing it post dive , it is also easy to allow another diver who may feel he has violated his ascent to breath off the bottle as a precaution .I feel this situation is the same as if the diver asked the dive Marshall/Skipper to open the emergency oxygen supply once they have done this they must follow the procedure or risk being sued.
The purchase of O2 as a decompression gas or as a medical gas may be different and its intended use may be different but in this instance the end use is the same, as a precautionary measure for suspected dcs . If all went well and the diver showed no signs of dcs at the very least this would be classed as an incident , if this was a club dive an incident report would need to filed giving details of what happened and the treatment given this is a legal document which could be used in a court of law.

If a diver had a rapid ascent you allowed him to use your decompression gas and he breathed this for 10 mins then said he was OK. , 10 mins later he started to feel symptoms of dcs you put him back on O2 and called the coast guard. There has now been a 20 min delay in suitable treatment. O2 is only a "field dressing" the treatment is recompression.
If it could be proved the divers injuries had worsened due to the delay in treatment somebody could be sued.

If a diver on my boat asked for O2 I would have to inform the coast guard , now this may prevent a diver asking for O2 because of this but at the moment I have no choice .

Yours Alban

 

[Dr Deco]

Dear Readers:

”A Drug by Any Other Name…” :mean:

These are discussions/arguments good enough for lawyers and barristers. Some would attract the medieval scholastics. I will affirm my original position that many things are useful for off gassing and prophylactic treatment of DCS. Oxygen is common as are other things.

If we wished to exclude, we could say, for example, that

• coffee and tea are permitted if the desire is to correct cold or sleepiness but are not allowed if the desire is to increase heart rate and perfusion following a dive;
• water is OK if you are thirsty but not permitted for rehydration, surface tension control, and perfusion control for off gassing;
• oxygen is permitted if you feel light headed but not if you wish to foster nitrogen elimination.

I am still holding to the thought that what fosters the elimination of inert gas is good if it is considered a common substance – or relatively common. {At the other extreme end, I would not say that vasodilatation by the administration of sodium nitroprusside falls into this category, but that is certainly not a commonly available drug anyway.}

Dr Deco :doctor:

 

[TwoBitTxn]

I feel the need to pull out some definitions.. put us all in agreement.

Medicine: A substance or preparation used in treating disease.

Therapy: Remedial treatment of a bodily disorder.

Both are from Websters Ninth New Collegiate.

First off I feel that in order to administer oxygen to another person you should be trained. The O2 provider class is suitable training. It teaches proper use of the different types of delivery systems. ( simple mask, non-rebreather, etc) There is a new class out that teaches the use of the Bag valve mask. I don't know if it gets into oral airways.

Since we are talking more from a point of O2 therapy in the case of a accident or possible accident I will stick to this subject.

Alban, I agree with you. If I am dive master on a boat and someone messes up bad enough they feel they need O2, I am going to administer that O2, but I am also going to encourage the person seek additional medical attention, and if there is a refusal that person will give me that refusal in writing with a witness.

I will not labour the point, but it would seem you do not believe I should be entitled to use oxygen on the surface following any dive as an integral part of my decompression schedule solely because its "administration is a medical procedure" and therefore I should only use it on the surface when there is immediate and obvious evidence of DCI.

I agree with half of this Dr. Thomas. At the moment (I reserve the right to change my opinion) I feel if you need O2 not so much you have DCI symptoms but you have done something that could cause DCI (Blown a deco stop) you can have it from the emergency kit. If you are deco diving and wish to bring your own bottle of 100% O2 to breath off of thats your business, but you can't have my emergency supply.

In short... if its an emergency... its yours. You don't have to show signs for it to be an emergency. If you use it I will encourage you to seek further medical attention.. If you choose to deny medical attention I'll take that in writing.

TwoBit

 

[The Iceni]

Dr Deco once bubbled...
. . . we could say, for example, that

• water is OK if you are thirsty but not permitted for rehydration, surface tension control, and perfusion control for off gassing;
• oxygen is permitted if you feel light headed but not if you wish to foster nitrogen elimination.

Dr Deco :doctor:

Just how often have I been offered that bottle of water following a dive?

It may have been all my body needed to prevent that unexpected DCI so it was, in fact, medical treatment.

QED!

 

[Cherry]

Dr. Paul I think you have my feeling wrong... I believe that if I were to administer oxygen as a first reponder it would be considered a medical procedure hell if I put a bandaid on your finger with my qualifications it would be considered by our Workmans Compensation Board to be a medical procedure. If you were to put a bandaid on your finger after cutting yourself thats just plain common sence. I think that if you were to ask for oxygen to be turned on and self administer it thats just common sense too. Wether you are masking a probem or not I dont have the knowledge to discern but I suspect from previous posts you wouldnt be. From my experience with Hangovers and self administered O2, Oxygen is verrry good for me....

 

[The Iceni]

One of the things that consistently irritates me out-of-hours is certain calls from care assistants staffing nursing and residential homes.

If one of their "guests", who is also a patient of mine, develops a headache they are prevented from issuing an aspirin or a paracetamol tablet from the drugs cupboard without my permission.

Bureaucracy gone mad!

 

[Alban]

Dr D

I don't think anyone would argue the benefits of giving O2 , if a diver had a good ascent and conducted all his stops and continued breathing O2 on the boat I would class this as continued decompression .

Dr T I have not voted in your poll because I feel it is slightly missleading for the following reasons :

"Yes, it must only be used for established DCI"
It is not necessary to wait for symptoms of dcs quite the opposite.

"No, it should be more widely used to prevent DCI"

"Surely prevention is better than any attempted cure?"

O2 will not prevent or cure dcs. I think you are suggesting that O2 will prevent a hit .While I understand there are many degrees of dcs will breathing O2 really prevent a HIT.

"If the nitrogen dose were sufficient, all decompressions would develop into a case of DCS (assuming that micronuclei were present). " Dr Deco.

Would anyone like to give details when they would administer O2 and not notify the coast guard ( depth , bottom time , missed stops ) ?


Yours Alban