Supplemental oxygen

If contractions are frequent, prolonged, or excessive, die infusion is stopped to prevent fetal anoxia or trauma to die uterus. Excessive stimulation of die uterus can cause uterine hypertonicity and possible uterine rupture. The nurse places die patient on her side and provides supplemental oxygen. The effects of die drug diminish rapidly because oxytocin is short acting. 

Patients should be educated to recognize the signs and symptoms of complications that would require urgent evaluation. Patients and parents of children with SCD should be educated to read a thermometer properly and to seek immediate medical care when a fever develops or signs of infection occur. With acute illnesses, prompt evaluation is important because deterioration may occur rapidly. Fluid status should be monitored to avoid dehydration or overhydration, both of which may worsen complications of SCD. Patients in acute distress should maintain oxygen saturation at 92% or at their baseline. Any supplemental oxygen requirements should be evaluated.6,27... 

Inhalation Prompt medical attention is mandatory in all cases of overexposure. Rescue personnel should be equipped with self-contained breathing apparatus. Conscious victims should be carried (not assisted) to an uncontaminated area and inhale fresh air with supplemental oxygen. Quick removal from the contaminated area is most important. Keep the patient warm, quiet, and under competent medical observation until the danger of delayed pulmonary edema has passed (at least for 72 h). Any physical exertion during this period should be discouraged as it may increase the severity of the pulmonary edema or chemical pneumonitis. Bed rest is indicated. Unconscious persons should be moved to an uncontaminated area, and if breathing has stopped, administer artificial resuscitation and supplemental oxygen. Once respiration has been restored they should be treated as above. 

Mineral Oil Hydraulic Fluids. No specific methods were located for interfering with the mechanism of action for toxic effects produced by mineral oil hydraulic fluids. Unstable alveoli and distal airways have been proposed as major factors in the respiratory symptoms that occur after the ingestion of other petroleum-derived materials. Continuous positive airway pressure or continuous negative chest wall pressure, as well as the application of supplemental oxygen, have been recommended to counteract the resultant pneumonitis (Eade et al. 1974 Klein and Simon 1986). 

Crowley JS, Wesensten N, Kamimori G, Devine J, Iwanyk E and Balkin T (1992). Effect of high terrestrial altitude and supplemental oxygen on human performance and mood. Aviation, Space and Environmental Medicine, 63, 696-701. 

Injuries and fatalities from asphyxiation are often associated with personnel entry into inerted equipment or enclosures. Guidance on safe procedures for confined space access are provided by OSHA (OSHA, 29 CFR 1910.146, Confined Space Entry Standard, 2000), the American National Standards Institute (ANSI, Z117.1, Safety Requirements for Confined Spaces, 2003), Hodson (Hodson, Safe Entry into Confined Spaces, Handbook of Chemical Health and Safety, American Chemical Society, 2001), and BP (BP, Hazards of Nitrogen and Catalyst Handling, 2003). OSHA has established 19.5 vol % as the minimum safe oxygen concentration for confined space entry without supplemental oxygen supply (see Table 23-18). Note that OSHA imposes a safe upper limit on 02 concentration of 23.5 vol % to protect against the enhanced flammability hazards associated with 02-enriched atmospheres. 

Quickly ensure ABC (airway/breathing/circulation). See that the victim has a clear airway. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard if feasible. Check for adequate respiration, and administer supplemental oxygen if cardiopulmonary compromise is suspected. Maintain adequate circulation. Establish intravenous access when necessary and warranted. Use a cardiac monitor as necessary. Stop any bleeding when necessary. When ingestion is evident, do not induce emesis (vomiting). For victims who are alert and able to swallow, give four to eight ounces of milk to drink. Administration of activated charcoal is not viewed as beneficial. 

Data adequacy The study was well conducted and documented. Supporting data include both human and animal studies. Animal studies covered acute, subchronic, and chronic exposure durations and addressed systemic toxicity as well as neurotoxicity, reproductive and developmental effects, cardiac sensitization, genotoxicity, and carcinogenicity. Other effects in animal studies occurred at much higher concentrations or with repeated exposures the latter are not relevant for setting short-term exposures. No deaths occurred in several species of animals exposed for various periods of time to concentrations less than those requiring supplemental oxygen (approximately 700,000 ppm). ... 

Emergency airway support and 100% supplemental oxygen with assisted ventilation under medical supervision may be necessary. 

Exposed individuals with evidence of central nervous system depression or seizures should be evaluated for the presence of some other underlying disorder. Diazepam or phenobarbital may be administered to alleviate seizures. Supplemental oxygen can also be administered. If pulmonary edema occurs, conventional therapy should be considered. Additional information regarding the treatment of individuals exposed to cresols may be obtained from Bronstein and Currance (1988), Haddad and Winchester (1990), and Stutz and Janusz (1988). 

If carbon tetrachloride has been inhaled, movement to fresh air is recommended. Humidified supplemental oxygen (100%) may be administered as required. 

A variety of supportive measures can be used, including cooling blankets, ice packs, or an ice-water enema. The goal should be to return the temperature as close to normal as possible. One should also be ready to treat complications and give supplemental oxygen with or without mechanical ventilation (the amount of oxygen and the method of delivery will depend on the patient s needs). 

If exposure is via inhalation, the exposed individual should be moved to fresh air and efforts should be directed toward the maintenance of an open airway, airway suctioning, endotracheal intubation. Artificial ventilation with supplemental oxygen may be helpful. 

An apparent association between severe retinopathy of prematurity and dexamethasone therapy has been shown in a retrospective study (SEDA-20, 372 76). Infants treated with dexamethasone required longer periods of mechanical ventilation (44 versus 26 days), had a longer duration of supplemental oxygen (57 versus 29 days), had a higher incidence of patent ductus arteriosus (28/38 versus 18/52), and required surfactant therapy more often for respiratory distress syndrome (17/38 versus 11/52). Prospective, randomized, controlled studies are needed to correct for differences in severity of cardiorespiratory disease. Until such studies are available, careful consideration must be given to indications, dosage, time of initiation, and duration of treatment with dexamethasone in infants of extremely low birthweight. 

Anzai Y, Ishikawa M, Shaw DW et al (2004) Paramagnetic effect of supplemental oxygen on CSF hyperintensity on fluid-attenuated inversion recovery MR images. AJNR Am J Neuroradiol 25 274-279... 

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