O2 bad for heart attack patients

[clockworkdog]

All

A good friend of mine from the Royal Society of Medicine sent me the folowing link:

http://www.rsm.ac.uk/media/pr236.htm

It puts an interesting perspective on providing O2 for people suffering an MI. The process of drowning is a complicated thing and a number of things happen along the way (osmosis etc.) but usually a heart attack occurs in the end.

Anyhow - just food for thought and an interesting potential u-turn. An MI being a contraindication for O2 seems bizzare.

I suspect we are a long way away from new MI treatment guidelines. Apart from that, for a surface incident it is very difficult for a `first-aider' to confidently tell the difference between angina and an MI - knowing to ask when the pain came on, how it came on (stable or unstable), what was the patient doing prior to onset, whether it goes away, has it happened before, etc. Hopefully not too many divers would be angina sufferers though!

Andy

[frosty the snowman]

Interesting concept. As you said though, people with the cardiac conditions to which this applies shouldn't be diving anyway. Oxygen is contraindicated in a number of conditions although some of the potential problems are rarely seen. It's also worth stating that having done an oxygen administration for divers course we can only give oxygen to divers for diving related conditions. Shame a certain banned member who believes oxygen is poisonous can't comment here. I could do with a laugh!

[clockworkdog]

Originally Posted by frosty the snowman

Interesting concept. As you said though, people with the cardiac conditions to which this applies shouldn't be diving anyway. Oxygen is contraindicated in a number of conditions although some of the potential problems are rarely seen. It's also worth stating that having done an oxygen administration for divers course we can only give oxygen to divers for diving related conditions. Shame a certain banned member who believes oxygen is poisonous can't comment here. I could do with a laugh!

Are you thinking of COPD as a contraindication? I personally can't think of any that are a contraindication?

True that if people's only qualification re O2 is dive related then their course may limit them as to when they can give it.

Andy

[frosty the snowman]

Originally Posted by clockworkdog

Are you thinking of COPD as a contraindication? I personally can't think of any that are a contraindication?

Well that's my point really. COPD is often quoted as a condition for which oxygen shouldn't be given but in a hospital environment where ventilatory support is available, any reduction in respiratory drive can be dealt with so we tend to give oxygen anyway. I guess there will always be diferences both in the theoretical and practical situations but also what happens in a nice dry hospital versus what happens in a boat 12 miles off Plymouth.

[clockworkdog]

Originally Posted by frosty the snowman

Well that's my point really. COPD is often quoted as a condition for which oxygen shouldn't be given but in a hospital environment where ventilatory support is available, any reduction in respiratory drive can be dealt with so we tend to give oxygen anyway. I guess there will always be diferences both in the theoretical and practical situations but also what happens in a nice dry hospital versus what happens in a boat 12 miles off Plymouth.

Agreed to an extent but COPD is not a contraindication out of hospital either. It used to be but then common sense took over and the necessity for O2 for shock overides COPD. If the casualty resp rate drops or stops then this can esaily be managed outside of hospital with ventilation (preferably via ET). Even on a boat if a casualty's O2 sat levels were dropping then your gonna have to administer O2 before they fall through the floor even if they have COPD (don't think you'd see a COPD on a dive boat somehow though! - maybe a ferry ).

It's easy to deal with all of this when you are HPC registered but probably a bit scary for someone just qualfied as a diving O2 administrator, many of whome won't know about COPD etc. As you said - one of the reasons that they shouldn't administer O2 to non-diving casualties.

[frosty the snowman]

Originally Posted by clockworkdog

It's easy to deal with all of this when you are HPC registered

True!

The problem is that some people will cherry pick they (think they) understand and wrongly apply them. Much like the ex member whom I mentioned.

[clockworkdog]

Originally Posted by frosty the snowman

True!

The problem is that some people will cherry pick they (think they) understand and wrongly apply them. Much like the ex member whom I mentioned.

Very very true and get into very hot water. Well said.

[jackdiver]

Originally Posted by clockworkdog

It's easy to deal with all of this when you are HPC registered but probably a bit scary for someone just qualfied as a diving O2 administrator, many of whome won't know about COPD etc. As you said - one of the reasons that they shouldn't administer O2 to non-diving casualties.

Okay, I'll bite.

What is COPD?

Cheers.

[dlegros]

Chronic Obstructive Pulmonary Disease.

It is a degenerative condition covering such things as emphysema where there is permanent lung damage.

In some patients with COPD, the physiology that causes you to breathe changes and instead of relying on high pCO2 in the blood, they rely on low pO2, thus administering high flow oxygen can cause respiratory distress and even ventilatory failure.

However, even in COPD hypoxia (low oxygen) kills - we go for high flow oxygen until arterial blood gas analysis gives us more information.

As for contraindications to oxygen - Paraquat poisoning, as high oxygen levels increase the toxicity in the acute phase.

HTH

[Mary]

Originally Posted by clockworkdog

Apart from that, for a surface incident it is very difficult for a `first-aider' to confidently tell the difference between angina and an MI

I'll just whip out my pocket 12 lead ECG machine shall I? Only definative way to tell between the two even then there are somethings which look like MIs on 12 lead with aren't.