High-flow oxygen may be on its way out...

[VentMedic]

Think that through logically.... if it is nothing but compressed atmosphere, what benefit is there in applying it?

Many home care ventilator patients do not need supplemental O2 and will just run of the compressed air from the vent's compressor. (ex. Christopher Reeve)

Infants with cyanotic heart disease may also be ventilated by 21%.

Often both compressed air and O2 are blended for infant transport ventilators for more stability of FiO2 delivery as opposed to some venturi methods on some adult transport ventilators.

Anyone working with any type of medical gas should also be able to identify the tank by the Diameter Index Safety System (DISS) and Pin Index for added safety regardless of the color of the tank.

The exception again will be for those that work with Neo/Pedi transport teams that will run other gases through they ventilators other than O2 and Air. This could include Helium, Nitrogen, CO2 and Nitric Oxide. They will use a custom high pressure hose that has the specific gas connector at one end and either an O2 or Air connector at the other end to couple with the ventilator. This can present some hazards if you are not well versed in the different gases used by the teams.

I hope the welding supply company was supplying you with medical grade O2 and not industrial grade. QA can be a pain when when using some cascade systems.

Medical grade O2 is pure oxygen.

Oxygen Bars are able to slide under the law by providing oxygen which is slightly higher than an FiO2 of 0.21 from an industrial grade concentrator.

Home care patients use medical grade concentrators which may provide close but not quite the same O2 concentration for liter flow as from an O2 tank. In other words, a patient that is on 5 L/min NC on a home concentrator may only be the equivalent of 2.5 - 4 L from a tank depending on the make, model and service record of the concentrator.

[Lone Star]

Is Michigan the only state that has discontinued using the Venturi mask?

[ccmedoc]

One consideration that we have to factor in, especially out in the field is this:

Are we actually using 100% oxygen in our portables, or are we actually delivering nothing more than compressed atmosphere?

In Michigan, the color coding for the receptacles for 'pure oxygen' is yellow, and the receptacles for 'compressed atmosphere' is green.

Since our portable tanks are color coded in green, wouldn't the same color coding apply as well?

I know that the service I worked for in Detroit would fill their own portable tanks from a 'cascade system' (which we also used for the fire department), and the 'supply tanks' were refilled from a local welding supply.....

I know that in MI, to give 'pure oxygen' (which I'm presuming is what they're referring to when they reference 100% oxygen), required a doctor's order, but the green tanks (which as I've stated before contained nothing more than 21% compressed atmosphere), we could administer PRN.

Color coding for gas administration is universal..not just to Michigan..

At the risk of starting a fray..Green is indeed for compressed oxygen..generally assumed to be the medical grade 100% variety..

Yellow coding is simply air, compressed 21% oxygen....general atmosphere, nothing less..

The tanks in the ambulances, and everywhere else that carries green oxygen tanks are indeed 100% pure oxygen..whether it is medical grade or not is in the additional labeling..Be sure that you should need an order for these and, as I have said before, too much oxygen is not a good thing, so be careful..

I don't know what to make of the venturi mask comment...we use them quite often in ICU, and they can be used on the ambulance with the correct orders..transfers and such..I don't think Mi. has discontinued them, maybe just certain companies don't buy them..All the ambulance services I have been associated with carry or inservice on them at some point in training..

[Christopher.Collins]

Interesting read... thanks Spenac.

Anyways, out of curiosity (if anyone knows)... how do they get to testing this and other new procedures (that would require immediate useage) on people? I am to assume that it must be done and succeed many times before they could make it an actual protocol to withold high flow in such cases, and that a pt or immediate family must consent to experiemtnal procedures. Also, its not like you can always consult the pt's family as this would be a treatment that would be with-held immediatley and family wont always be available. I can see how it works for concious pt's and pt's with family immediatley available, or in the case of prcedures that dont need to be performed right away (incase both the afore mentioned are not applicable). Just wondering. Always loved a job like this where theres always something new and informative to learn.

[VentMedic]

The color of the tank can be misleading. It is better to check the label, the DISS and Pin Index. There are many different composite tanks on the market and even in home care you may have patients on different gases by portable tanks with Nitric Oxide. Mixed gases may have a green should but may contain the majority in another gas such as an HeliOx mix of 70/30 where only 30% is O2. Never assume anything.

The international color code has a different color coding: O2 - white, N2O - blue, Air - white & black. It is not uncommon to see these tanks also mixed in with the others in some parts of the U.S.

Industrial O2 may be black and Scuba tanks come in a variety of colors even for the mixed gases. Pure O2 may have a white shoulder. Check the label.

I like venturi masks since they are a true high flow but at a low FiO2. NRBMs are actually not "high flow". They are limited at whatever flow you set them for.

Testing and researching Oxygen? Guess why I became a Respiratory Therapist? The other reason was to be able to do so much more for a patient's breathing problems than I could ever do as a Paramedic. We have been doing research through special grants for many years. Just one of the journals that carry such research is:

http://www.rcjournal.com/

Almost any medical journal will give you their methodolgy for research. If you want more information, there may be an email listed. In the reference section of even JEMS, you can check out the links to the serious medical journals.

EMTs and Paramedics don't believe that other health care professionals have "protocols". However, when we enact our protocols in the hospital there will be many different pathways and guidelines to choose from. We are not bound by "recipes". Even within the same hospital we may utilize several different variations of an ARDS, Acute Lung Injury, Lung Protective Ventilation, TBI or Sepsis protocol. The protocols will be written for both the RN and the RRT. Research may be pulled from careful documentation at a later date or the patient's data will be entered into a collective database for multiple studies.

[Novisen]

Some interesting links!

http://www.emedicine.com/ped/topic2598.htm

Also take a look at the Air/Oxygen Blender and the NeoPuff that we use in the OR

http://www.junnimed.com/products4.htm

http://www.fphcare.com/neonatal/resuscitation_products1.asp

http://www.sciencedirect.com/science?_ob=A...2c61330f349a474

[larry 1745]

the thing about scuba diving is that is that they can add what ever gasses you request into your tank depending on what qualification you are and what you intend to do with it, like nitrox diving which alows you to have a longer bottem time than the regular diver but you have to have a certain level of training and cert to do that.