Defibrillation w/ high flow O2

[NoahG]

Hey all,

What is your thoughts on cardioversion or defibrillation with high fly O2 and ventilating the pt? I really never raised an eyebrow until another medic student who works full time for several years with a local county states each time they shock they remove the O2 from the pt and away from the cot until the shock is delivered in case a loose patch causes a spark which could cause combustion with the O2. Is this likely to happen or a good habit to get into or just plain non sense?

Another note for having an advanced airway in place I could see removing the BVM between shocks could cause a displaced tube which would not be a good thing I'm thinking.

Thanks again.

[Timmy]

In EMS we were taught to always keep the BVM away from the patient when shocking. I don’t think there is an extreme risk of the oxygen combusting but I guess the risk is still there. I’ve never seen a defib emit a spark but I guess it’s always possible.

I wouldn’t be removing the BVM from the ET tube because of the associated risks.

I guess the best advice anyone can give is just do what you’ve been trained to or what your policy dictates, that way your covered either way.

[HERBIE1]

Arcing/sparking is much less likely these days since the advent of defib pads. When we used paddles, it would occasionally happen- especially with small, thinner patients, when it was sometimes difficult to get good contact with the chest wall..

I've never turned off the O2 when defibrillating or cardioverting, but I usually do remove the BVM from the ET- if the patient jumps enough, it can torque the ET tube if the BVM is still attached to it..

[JPINFV]

Oxygen doesn't combust on it's own. It's a requirement for fire, but it isn't the only requirement.

[chbare]

Also, 15 LPM into a BVM is not really considered "high flow" oxygen. High FiO2, yes, high flow, no. Perhaps an academic point, but one I try to clear up with other providers nonetheless.

Take care,

chbare.

[DwayneEMTP]

Also, 15 LPM into a BVM is not really considered "high flow" oxygen. High FiO2, yes, high flow, no. Perhaps an academic point, but one I try to clear up with other providers nonetheless.

Take care,

chbare.

That's a great addition. Can you define the difference for the benefit of the thread? You're explanations are always way better than Google...

Dwayne

[zippyRN]

That's a great addition. Can you define the difference for the benefit of the thread? You're explanations are always way better than Google...

Dwayne

look at the gas flows produced by a venturi mask - that is high flow of a fixed concentration

A bvm or NRB is a medium flow of a high but variable concentration - seal, minute volume etc

i think the issue is much less of one now the majority of defibrilation is 'handsfree' and the Oxygen away is a practice from the old days along with the 25 Lb thing

[chbare]

The easiest way I look at it is a high flow device can meet all of the patient's inspiratory flow demand. If you figure a normal patient call pull something like 30-40 LPM, it is easy to appreciate how a device like a non rebreather cannot be high flow at 15 LPM.

Take care,

chbare.

[DwayneEMTP]

The easiest way I look at it is a high flow device can meet all of the patient's inspiratory flow demand. If you figure a normal patient call pull something like 30-40 LPM, it is easy to appreciate how a device like a non rebreather cannot be high flow at 15 LPM.

Take care,

chbare.

Hell, I asked you to explain because I was in a hurry, but it turns out I didn't know the answer anyway. Cool, clear explanation from both you and Zippy, thanks for taking the time to do that!

Dwayne

[NoahG]

Thank you for the positive feedback everyone.

Thank you for helping clear up the "high flow" clarification zippy, chbare and Dwayne!

NoahG