NITRONOX, IT’S NO LAUGHING MATTER…OR IS
IT?
SOUTH PIERCE FIRE AND RESCUE PRESENTS
-NITROUS OXIDE AND YOU-
Nitronox Field Unit
OBJECTIVES
• Review pharmacology of Nitrous Oxide/Oxygen mixture
• Discuss and treatment for pain management
• List indications and contraindications for use of Nitronox in the
EMS setting
• Identify potential side effects
• Discuss proper dosing and administration
• Demonstrate proficiency with the Nitronox Field Unit
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DILEMMA OF ANALGESIA
• When is analgesia required?
• Which agent/technique should I use?
• What is the risk-benefit ratio?
• How much should I administer?
**Narcotic Naive?
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THE IDEAL ANALGESIC
• Safe with few side effects
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Effective and rapid acting
Easy to administer, store, and carry
Has a short duration and easily reversible
Not easily abused
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NITRONOX-PROPERTIES
• Blended mixture of 50% nitrous oxide and 50% oxygen
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Produces sedation and analgesia
Colorless, odorless, heavier than air
Non-explosive, nonflammable
Provides a sedative effect which decreases the patients perception
of pain and lowers anxiety.
• May partially act on opiate receptors to cause mild analgesia
• Readily diffuses through membranes
*Rapid onset
*Short duration (after inhalation has been stopped)
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1.
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INDICATIONS
Acute myocardial infarction, angina.
Musculoskeletal pain due to poss. fractures.
Burns.
Severe pain with physician approval.
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CONTRAINDICATIONS
1.Severe head injury with evidence of increased intracranial pressure,
decreased LOC.
2. COPD, pneumothorax.
3. Bowel obstruction, abdominal pain.
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SIDE EFFECTS
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Dizziness/headache/confusion
Apnea*
Cyanosis*
Nausea/vomiting*
Hypotension*
May worsen conditions involving abnormal collections
of air as in: Pneumothorax
Bowel Obstruction
*Rarely seen
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USE WITH CAUTION
• May see transient decrease in pulse upon discontinuing
use. (Wash-out effect).
**Always monitor patient with pulse oximeter and provide
appropriate supplemental oxygen as needed.
**Always administer in well ventilated environment.
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NITRONOX ADMINISTRATION
• ALWAYS SELF– ADMINISTERED BY PATIENT
WHO IS AWAKE, ALERT, AND COOPERATIVE!
• Instruct patient to inhale deeply through the patientheld demand valve.
• Patient determines number of inhalations and
duration of therapy required for adequate pain relief.
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Fail-Safe
• If oxygen tank runs out- audible alarm and no gas delivery.
• If nitrous oxide tank runs out- audible alarm with 100% oxygen
delivery to the patient.
• If the oxygen line pressure drops or becomes disconnected, the
nitrous oxide flow and the supply valve flow stop automatically.
• If the nitrous oxide supply runs out or is shut off, the supply valve
continues to provide 100% oxygen at a reduced peak flow of about
70 lpm.
• If the patient takes abnormal shallow breaths (100 to 200mL tidal
volume), oxygen concentration automatically increases
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Capacities
TID-BITS
• The Nitronox system is capable of delivering peak flows of up to 140 liters
per minute at normal breathing rates and volumes.
• Mixture concentration is factory set at 50% nitrous oxide and 50% oxygen
(± 5 percentage points oxygen), however, designated high-altitude models
are set at 65% nitrous oxide and 35% oxygen (± 5 percentage points
oxygen).
• ALS procedure in Pierce County at this time. However, application could be
made at scene and pt. transferred to BLS crew. Example: Pt in pain with
movement but fine once on bed.
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FIELD UNITS
• Carrying case containing 1 Nitrous cylinder. (Each cylinder last
approximately 30 minutes).
• Mixer with valve to ensures premixed 50:50 delivery of gas.
• Oxygen supply hose.
• Demand valve to prevents free flow of gas when not in use by
patient.
*Negative pressure required to open demand valve. (Good seal and
patient effort).
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UPreparation for Use
PREPERATION FOR USE
• Replace the nitrous oxide
cylinder after each use.
• One cylinder contains
approximately a 30 minute
supply which is long
enough for most single
missions
• Remove the mixer
assembly from the carrying
case
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Preparation for Use
• Remove the tear-off cap
from the outlet of a fresh
cylinder of nitrous oxide.
• Inspect the female
connector on the mixer to
assure that the o-ring is in
place
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Preparation for Use
• Attach the nitrous oxide
cylinder to the mixer
assembly by turning the
hand wheel clockwise
until it is "hand tight"
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Preparation for Use
• Check the connection by opening the
cylinder valve slightly and listening for
leakage.
CAUTION
Always turn on cylinder valves slowly and
fully.
• If a "hissing" noise is heard, close the valve
and remove the cylinder.
• Check to ensure that the O-ring is present
and in good condition.
• Re-assemble and check the connection
again to be sure that there is no leakage or
"hissing" noise.
• If the connection is not leaking, close the
valve.
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Preparation for Use
• Install the cylinder/mixer
assembly in its case.
• Make sure that the mixture
pressure gauge is visible.
**When cylinder is open,
normal is 30-35 psi (green
band). Pressure will decrease
slightly during each inspiration
by the patient.
• The apparatus is now ready for
use
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Op
Patient Use
1. Attach the face mask, or the mouth
piece to the supply valve.
2. Instruct the patient to hold the face
mask lightly on the face, covering the
nose and mouth or seal lips over the
mouth piece.
3. Instruct the patient to breathe
normally.
WARNING
Patient must self-administer at all
times.
NOTE: If the mixture pressure drops below 30
psi and whistle alarm sounds during
inhalation, the nitrous oxide cylinder valve
is closed or the cylinder is empty.
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Operation
After use, turn off all cylinder valves and
disconnect the oxygen supply. Clean the
valve and dispose of the mouthpiece. Prepare
the apparatus for the next use
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Nitrous Oxide Cylinder
Replacement
Make sure the nitrous oxide cylinder is replaced after each use. One
cylinder contains approximately a 30-minute supply-which is long enough
for most single missions.
To replace the nitrous oxide cylinder:
1. Make sure the nitrous oxide cylinder
valve is in a fully closed position by
turning the valve knob clockwise until it
stops. Ensure that the oxygen supply
to the unit is off and disconnected.
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Nitrous Oxide Cylinder Replacement
2. Remove the mixer assembly from
the carrying case as
3. Hold the assembly in the upright
position.
4. Slowly unscrew the large hand
wheel by turning it counterclockwise.
WARNING
If a hissing sound is heard, stop and
recheck that the cylinder valve is
closed and that the oxygen supply is
off.
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Nitrous Oxide Cylinder Replacement
5. Continue by removing the cylinder
and valve assembly.
6. Tag the cylinder to show it is no
longer full and return the cylinder to a
secure storage area.
7. Remove the tear-off cap from the
outlet of a fresh cylinder of nitrous
oxide and inspect the female
connector on the mixer to assure that
the O-ring is in place.
8. Attach the cylinder to the mixer
assembly by turning the hand wheel
clockwise until "hand-tight".
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Nitrous Oxide Cylinder Replacement
9. Check the connection by
opening the valve slightly and
listening for leakage. If hissing is
heard, close the valve and
remove the cylinder. Recheck to
ensure that the O-ring is present
and in good condition.
10. Reassemble and check the
connection once more to make
sure there is no leak If the
connection is not leaking, close
the valve.
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Nitrous Oxide Cylinder Replacement
10. Reassemble and check the connection
once more to make sure there is no leak If
the connection is not leaking, close the valve.
11. Reinstall the mixer/cylinder assembly in its
case as shown.
• Make sure the mixture pressure gauge is
visible.
• Always store the Nitronox® unit in a secure
area and use the double zipper feature to
seal and lock the case.
The apparatus is now ready for use.
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SUMMARY
• Nitronox is a safe, easy to use gas mixture containing 50% nitrous
oxide and 50% oxygen.
• Indicated for patients that are alert, cooperative, and complaining of
severe pain.
• Effective, rapidly acting with easily reversed affects.
• Used as an analgesic for several medical and traumatic indications
including chest pain after full initiation of ACLS protocol.
• Few contraindications or side affects
• NEVER administered by EMS personnel- only self-administered by
patient- limiting chances of overdose.
• Should be used in well ventilated areas.
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CONCLUSION
• The Nitronox Field Unit is a non-invasive, simple to use,
mechanism for delivery of Nitrous Oxide.
• Nitrous oxide has very few side effects or
contraindications. With rapid onset of pain management
and minimal risk of overdosing your patient, Nitrous
Oxide is the ideal analgesic agent for use in emergency
medicine.
• Overall, nitrous oxide has a comprehensive record
spanning many decades and millions of patients.
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Mixture Pressure Adjustment
If you have further
questions please contact
A/C Yount or F/F Etherton
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