Entonox in Canada

[Siffaliss]

Pretty much the same in BC but we also have a diving contraindication.

Suspected barotrauma is also a contraindication in AB.

[Quakefire]

We have it in Sask, added last year in the PCP scope, was used by medics and EMT-A before that. Has the inability to hold the mask, pneumo and bowel obstruction contraindications and so forth. Works well in some cases, generally it requires the patient to listen to you.

[AmboGuy]

We also have the diving contraindication here.

Methoxyflurane was introduced a couple years back here, it has been used in AU for years. There is rumour that this is going to replace entonox because of it is cheaper and more portable.

[AmboGuy]

As an advanced care paramedic from Queensland, and previously qualified as a PCP in British Columbia, I can relate to both Penthrane and Entonox, as I have used both.

Penthrane is for those who don't know, an inhaled analgesic, but highly addictive, in Australia, there are limits to it's use on patients - contra "hx liver kidney or liver disease, known severe reaction, more than one previous dose in the past four weeks for the same condition", you can fit two doses and the "whistle" in a shirt pocket, ideal for remote access, not having to carry a cylinder in with you!!, in saying this, and people seeing the Australian "surviver" episode where a member suffered burns, and was treated with methoxyflurane (Penthrane), but wiki Penthrane and you will soon see that it may never be used in North America, regardless of it's proven use pre hospital.

Entonox in Australia is used in all states and territories from volunteer (I was a volunteer in South Australia (St John Ambulance Service (not brigade, we were the ambulance service)), and Tasmanian Ambulance Service, right through to ALS (yes ALS still have a use for it) I have used it extensively for abdo pain (with bowel sounds) fractures, excellent on little old ladies with #nof, in B.C (and probably other areas of Canada) it is included in the chest pain protocol to continue analgesia (not to mention calming) of the chest pain patient until nitro can be resumed. In Queensland this was not practiced but I think it maybe should be!!, but as long as the BP was

[AmboGuy]

Content. As long as BP remained above 100, you could give 1 tablet or spray q5 on scene, to a max of three on scene doses, then 1 spray/ tablet q10 en route, indefinitely as Long as not contra indicated (BP below 100), but if the BP dropped, well it was oxygen only, though the ami guideline didn't say you couldn't use Entonox, you are caught because they must receive high flow oxygen, making it's use a problem, though Entonox benefits are many.

Cautions Qld; reduced LOC, alcohol intixification, pts unable to understand/comprehend instructions, aero medical Evac. British Columbia; depressant drugs, maxillo-facial injuries, COPD (COAD in oz, nz) distended abdomen, shock.

Contra indications Qld; chest injury/pneumothorax, air embolism/the bends, scuba dive last 24 hours, bowel obstruction. BC; inability to ventilate an enclosed treatment area*, inability to comply with instructions, suspected inhalation injury, suspected air embolism/pneumothorax, pt has taken nitro in last 5 mins, decompression sickness.

*north American ambulances have a pt care compartment vent system so paramedics Including those driving, don't get stoned, those of you in aust/nz that have input to ambulance design please note this and implement changes!!!

Guy

Entonox

[BEorP]

Penthrane is for those who don't know, an inhaled analgesic, but highly addictive, in Australia, there are limits to it's use on patients

Are you saying that methoxyflurane is addictive? According to their information sheet here, there is not evidence that it is addictive.

Edited July 22, 2012 by BEorP

[Kiwiology]

Entonox is good stuff, been used here for decades, Australia seems to favour methoxyflurane, we have it here in NZ but only for very rural stations where resupply of entonox is a problem or for space or weight limited areas e.g. Motorcycle or Ambulance Rescue

[Arctickat]

I've wanted to pipe the tank into my air intake on my ambulance.....but I suspect the Diesel would explode spectacularly.

[Quakefire]

I've wanted to pipe the tank into my air intake on my ambulance.....but I suspect the Diesel would explode spectacularly.

Actually Nitrous can be used on diesel motors, usually in conjunction with propane injection (propane for fuel and NOS for the oxygen) makes huge horse power gains. May actually stop some of the units from dragging their butts up the hills

[Arctickat]

Interesting...so eliminate the diesel fuel altogether or use the propane as an additive? I might consider something like that on my resto-mod.