View Full Version : Oxygen administration to a concious & breathing casualty
Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
Can anyone shed some light on this situation.
P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
Any relevant feedback welcomed.
Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
Can anyone shed some light on this situation.
P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
Any relevant feedback welcomed.
The 30 degree position is when a patient is receiving O2 therapy for breathing difficulties. O2 in a diving incident is usually to treat DCI. Supine - some debate as to weather to raise or not raise legs due to ?PFO involvement. In practice position the casualty how you canin the space availble. On a RIB legs will probably be raised due to all deck space having some kit lying on it!
Another Nurse....
Andy Wade
15-03-2004, 14:52
Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
Can anyone shed some light on this situation.
P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
Any relevant feedback welcomed.
We discussed this question in the Dive Instruct group a few years ago, as far as I know there hasn't been any change in thinking.
See link below:
:=Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
:=B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
:= He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
:=Can anyone shed some light on this situation.
:=P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
:=Any relevant feedback welcomed.
We discussed this question in the Dive Instruct group a few years ago, as far as I know there hasn't been any change in thinking.
See link below:
Andy Thank you for your reply, however the question was with regards to the casualty's body being placed at an angle greater than 3o degree,s and not the legs
cheers
atty
Andy Thank you for your reply, however the question was with regards to the casualty's body being placed at an angle greater than 3o degree,s and not the legs
cheers
atty
Same principal applies - you are aiming to reduce the blood pressure to avoid a shunt, therefore the flatter the better
Andy Wade
16-03-2004, 08:44
:=:=Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
:=:=B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
:=:= He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
:=:=Can anyone shed some light on this situation.
:=:=P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
:=:=Any relevant feedback welcomed.
:=
:=We discussed this question in the Dive Instruct group a few years ago, as far as I know there hasn't been any change in thinking.
:=See link below:
Andy Thank you for your reply, however the question was with regards to the casualty's body being placed at an angle greater than 3o degree,s and not the legs
Indeed.
But as Pete has said the effect is the same, please read the page again on Dive Instruct. The reverse incline of 30 degrees has a similar effect as raising the legs.
iainmsmith
20-03-2004, 02:36
:=:=:=Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
:=:=:=B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
:=:=:= He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
:=:=:=Can anyone shed some light on this situation.
:=:=:=P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
:=:=:=Any relevant feedback welcomed.
:=:=
:=:=We discussed this question in the Dive Instruct group a few years ago, as far as I know there hasn't been any change in thinking.
:=:=See link below:
:=
:=Andy Thank you for your reply, however the question was with regards to the casualty's body being placed at an angle greater than 3o degree,s and not the legs
Indeed.
But as Pete has said the effect is the same, please read the page again on Dive Instruct. The reverse incline of 30 degrees has a similar effect as raising the legs.
With all due respect, Andy, it does nothing of the kind.
Raising a casualty's legs allows venous blood to follow gravity and move downwards at the same time as limiting the arterial flow to the legs, again due to gravity (which is why one elevates a bleeding limb).
Sitting a casualty up does not create this effect as, if anything, the blood is now having to move against gravity to get to the heart. Obviously this would be a bad thing if also trying to treat shock, as the reduction in venous return would limit cardiac output and thus limit tissue perfusion. However, as Odin suggested, in the event of compromised lung function, it may be the correct thing to do in the interests of maximising what lung function is left.
Asthmatics and sufferers of chronic lung diseases will generally find it most comfortable to sit up during an attack, as it allows them to use accessory muscles to breath and removes diaphragmatic splinting by the abdominal contents, thus maximising the effectiveness of the lungs.
However, the comment made by the nurse on the course is not the full story. There is no absolute requirement that a casualty be sat up to receive O2 therapy. There are many situations where oxygen would be administered to a supine (lying down) casualty. An example would be in trauma, where one wants to maximise venous return to the heart to help compensate for significant blood loss and thus minimise the effects of shock.
If one considers lung injury, it may be most comfortable for a conscious casualty to sit up, for the reasons described above. Equally, an unconscious casualty with a chest injury would be placed in the recovery position with the affected side down, thus allowing any blood to drain from an open would or, at least, to allow the unaffected lung to work without being squashed by the weight of the heart and other chest structures pressing down on it.
The rationale for lying casualties down is, as I see it, twofold:
1) If they become dizzy or unconscious, they have no further to fall.
2) It is part of the correct management of shock.
OTOH, if one has an uncooperative casualty who refuses to lie down, but is prepared to sit, it's quite reasonable to accept that as a compromise, rather than getting into an argument with the casualty.
HTH,
Iain
(Dr and O2 Admin Instructor)
Andy Wade
20-03-2004, 09:30
:=:=:=:=Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
:=:=:=:=B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
:=:=:=:= He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
:=:=:=:=Can anyone shed some light on this situation.
:=:=:=:=P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
:=:=:=:=Any relevant feedback welcomed.
:=:=:=
:=:=:=We discussed this question in the Dive Instruct group a few years ago, as far as I know there hasn't been any change in thinking.
:=:=:=See link below:
:=:=
:=:=Andy Thank you for your reply, however the question was with regards to the casualty's body being placed at an angle greater than 3o degree,s and not the legs
:=
:=Indeed.
:=But as Pete has said the effect is the same, please read the page again on Dive Instruct. The reverse incline of 30 degrees has a similar effect as raising the legs.
With all due respect, Andy, it does nothing of the kind.
Raising a casualty's legs allows venous blood to follow gravity and move downwards at the same time as limiting the arterial flow to the legs, again due to gravity (which is why one elevates a bleeding limb).
Sitting a casualty up does not create this effect as, if anything, the blood is now having to move against gravity to get to the heart. Obviously this would be a bad thing if also trying to treat shock, as the reduction in venous return would limit cardiac output and thus limit tissue perfusion. However, as Odin suggested, in the event of compromised lung function, it may be the correct thing to do in the interests of maximising what lung function is left.
Asthmatics and sufferers of chronic lung diseases will generally find it most comfortable to sit up during an attack, as it allows them to use accessory muscles to breath and removes diaphragmatic splinting by the abdominal contents, thus maximising the effectiveness of the lungs.
However, the comment made by the nurse on the course is not the full story. There is no absolute requirement that a casualty be sat up to receive O2 therapy. There are many situations where oxygen would be administered to a supine (lying down) casualty. An example would be in trauma, where one wants to maximise venous return to the heart to help compensate for significant blood loss and thus minimise the effects of shock.
If one considers lung injury, it may be most comfortable for a conscious casualty to sit up, for the reasons described above. Equally, an unconscious casualty with a chest injury would be placed in the recovery position with the affected side down, thus allowing any blood to drain from an open would or, at least, to allow the unaffected lung to work without being squashed by the weight of the heart and other chest structures pressing down on it.
The rationale for lying casualties down is, as I see it, twofold:
1) If they become dizzy or unconscious, they have no further to fall.
2) It is part of the correct management of shock.
OTOH, if one has an uncooperative casualty who refuses to lie down, but is prepared to sit, it's quite reasonable to accept that as a compromise, rather than getting into an argument with the casualty.
You're absolutely correct Iain.
However, this is just a bit of a mix up.
I was referring to a "reverse incline" which has the body at an angle of around 30 degrees with the legs higher than the head.
IIRC it used to be part of diving first aid procedure, (I'm going back a fair bit) however it required the use of a board to lay the casualty on, and the same board could also be used to provide a hard surface to carry out CPR on in a crowded small boat.
It was impractical in a small boat and was eventually scrapped.
Our club certainly never used it.
Naturally it would be different from a 30 degree sitting position as the head would be higher than the legs.
Philip Smith
20-03-2004, 11:14
I was referring to a "reverse incline" which has the body at an angle of around 30 degrees with the legs higher than the head.
It was impractical in a small boat and was eventually scrapped.
I beleive another reason it was dropped (outside diving circles also) was that the weight of the stomach and intenstines would tend to bear on the diaphragm and lungs in a way that doesn't happen in a legs-raised/torso-flat position.
Philip Smith
Andy Wade
20-03-2004, 14:22
:=I was referring to a "reverse incline" which has the body at an angle of around 30 degrees with the legs higher than the head.
:=It was impractical in a small boat and was eventually scrapped.
I beleive another reason it was dropped (outside diving circles also) was that the weight of the stomach and intenstines would tend to bear on the diaphragm and lungs in a way that doesn't happen in a legs-raised/torso-flat position.
Yeah, that's right, the raised legs position was a halfway house that came about because the reversed incline was not suitable.
Later on the raised legs position was scrapped because of the PFO/pulmonary considerations.
Which led to the current thinking of just laying them flat on the ground.
.
Hi all
Been reading this with some interest, firstly as I understand things, if we are not treating a casualty for DCS, then it is unlikely that we would be adminitering O2, so when would we administer O2, a bad bleed or shock we say, ok perhaps, so a bad bleed, the limb would be raised, shock, the legs may be raised, difficulty with breathing after a dive sound svery like a symptom of DCS (BURST LUNG) which prbably means there a bubbles around, so the circle is complete
Remember as First Aiders we only treat symptoms, if we are lucky enough to have a Doc on board its a different ball game.
Best
JP
:=Our club has just run an o2 course and a question was raised by a trained Nurse on the course with regards to administering oxygen to a concious and breathing, casualty .
:=B.S.A.C. standard procedure to lay flat and administor oxygen. (if there are no signs or symtoms of burst lung or decompression sickness ) raise legs to counter for shock.
:= He has been trained to ensure the casualty is sitting at a angle of at least 30 degrees.
:=Can anyone shed some light on this situation.
:=P.S. This question was not openly asked and therefore did not distract from the procedure reccomended by B.S.A.C. but i have agreed to loook into the reasoning for the difference
:=Any relevant feedback welcomed.
We discussed this question in the Dive Instruct group a few years ago, as far as I know there hasn't been any change in thinking.
See link below:
Andy Wade
20-03-2004, 22:05
Hi all
Been reading this with some interest, firstly as I understand things, if we are not treating a casualty for DCS, then it is unlikely that we would be adminitering O2, so when would we administer O2, a bad bleed or shock we say, ok perhaps, so a bad bleed, the limb would be raised, shock, the legs may be raised, difficulty with breathing after a dive sound svery like a symptom of DCS (BURST LUNG) which prbably means there a bubbles around, so the circle is complete
Remember as First Aiders we only treat symptoms, if we are lucky enough to have a Doc on board its a different ball game.
Indeed.
We are as usual talking through and around the original topic, which is pretty normal in any conversation I guess.
It helps others to understand more about things, and they'll also remember more when some twit gets the wrong end of the stick (sorry folks...;-). As long as people learn more about the subject at hand, it doesn't matter too much how it gets discussed.
And we're all still friends I hope.
Hey, I've also learnt a bit more from it too, after Iain's excellent posting.
By the way, many congratulations on the 'Doctor' title Iain!
absolutely, we should never stop learning
best
jp
:=Hi all
:=
:=Been reading this with some interest, firstly as I understand things, if we are not treating a casualty for DCS, then it is unlikely that we would be adminitering O2, so when would we administer O2, a bad bleed or shock we say, ok perhaps, so a bad bleed, the limb would be raised, shock, the legs may be raised, difficulty with breathing after a dive sound svery like a symptom of DCS (BURST LUNG) which prbably means there a bubbles around, so the circle is complete
:=
:=Remember as First Aiders we only treat symptoms, if we are lucky enough to have a Doc on board its a different ball game.
Indeed.
We are as usual talking through and around the original topic, which is pretty normal in any conversation I guess.
It helps others to understand more about things, and they'll also remember more when some twit gets the wrong end of the stick (sorry folks...;-). As long as people learn more about the subject at hand, it doesn't matter too much how it gets discussed.
And we're all still friends I hope.
Hey, I've also learnt a bit more from it too, after Iain's excellent posting.
By the way, many congratulations on the 'Doctor' title Iain!
iainmsmith
21-03-2004, 20:51
You're absolutely correct Iain.
However, this is just a bit of a mix up.
I was referring to a "reverse incline" which has the body at an angle of around 30 degrees with the legs higher than the head.
Ah...my apologies for the misunderstanding. It sounds extremely uncomfortable!
Iain
Andy Wade
21-03-2004, 22:39
:=You're absolutely correct Iain.
:=However, this is just a bit of a mix up.
:=I was referring to a "reverse incline" which has the body at an angle of around 30 degrees with the legs higher than the head.
Ah...my apologies for the misunderstanding. It sounds extremely uncomfortable!
None needed mate, you actually answered the original question correctly.
I didn't read the question properly... what's the first rule of examinations? RTFQ.
Now the reverse incline was, whilst at first sight a fair idea, it was impractical at best, and virtually impossible in a small boat, and as most diving at that time was from small boats, it didn't really last long before being scrapped.
The incline/CPR board naturally went the same way.
Doctor Smith eh?
Marvellous stuff.
;-)
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