Nitronox. Why isn't it used anymore?

[TheLocalMedic]

Okay, researched around a bit and here's what I found about Nitronox...

Apparently NIOSH wants there to be no more than 25 ppm of nitrous oxide in ambient air that providers are breathing, and even with scrubbers and good ventilation, there can be upwards of 150 ppm circulating in the ambulance. Granted, this isn't approaching a therapeutic level where you're worried about getting goofy, but NIOSH is more concerned about the effects of long-term exposure for providers.

That being said, I think it's wonderful stuff. I've have both given it to patients and received it myself (after a gnarly arm fracture) and think that it's highly effective. I wouldn't be concerned about having it on board my ambulance, except the other issue to contend with is the high abuse potential...

 

[MikeCivitello]

Okay, researched around a bit and here's what I found about Nitronox...

Apparently NIOSH wants there to be no more than 25 ppm of nitrous oxide in ambient air that providers are breathing, and even with scrubbers and good ventilation, there can be upwards of 150 ppm circulating in the ambulance. Granted, this isn't approaching a therapeutic level where you're worried about getting goofy, but NIOSH is more concerned about the effects of long-term exposure for providers.

That being said, I think it's wonderful stuff. I've have both given it to patients and received it myself (after a gnarly arm fracture) and think that it's highly effective. I wouldn't be concerned about having it on board my ambulance, except the other issue to contend with is the high abuse potential...

TheLocalMedic -

NIOSH guidelines for nitrous oxide use are 25ppm time weighted average (TWA) for the duration of exposure. ACGIH has a 50ppm guideline over an 8 hour TWA (which is typically the TWA protocol followed).

Use of N20 where there is venting or good air circulation will minimize if not eliminate any potential exposure.

Can you share or cite where you found the "150ppm circulating in an ambulance"? I would be curious to read more about that and how it was measured and under what circumstances. Was this a documented study or just written somewhere? Also want to see what they are referencing with regard to "scrubbers" as such a thing for N20 does not exist. If someone could invent that they would really have something!

Bottom line - you can minimize the exposure by using in a well vented area and you can monitor exposure by wearing dosimeter badges periodically.

You are absolultey correct - it is the day in and day out chronic exposure that is the main concern. Particularly with "dental" applications - they are leaning over the patient and working in the mouth. If the patient exhales through their mouth (instead of into the nasal hood) - it is going right in the dentists and assistants face....

N20 has been used for over 100+ years with a very high safety record.

 

[Av8or007]

With the abuse risk, why not just treat the n2o as a narcotic and sign in in and out for each shift w the weight of the entronox cylinder recorded. Place a numbered tag on the cylinder that seals it until used on a call. The log would just contain the medics names, the tag number, the pre and post shift tank mass and a yes/no box for if it was used on a call.

 

[TheLocalMedic]

With the abuse risk, why not just treat the n2o as a narcotic and sign in in and out for each shift w the weight of the entronox cylinder recorded. Place a numbered tag on the cylinder that seals it until used on a call. The log would just contain the medics names, the tag number, the pre and post shift tank mass and a yes/no box for if it was used on a call.

^^ This

 

[Handsome Robb]

With the abuse risk, why not just treat the n2o as a narcotic and sign in in and out for each shift w the weight of the entronox cylinder recorded. Place a numbered tag on the cylinder that seals it until used on a call. The log would just contain the medics names, the tag number, the pre and post shift tank mass and a yes/no box for if it was used on a call.

I'm pretty sure that's how they used to do ours before it went away.

 

[Clare]

We've successfully used entonox for nearly forty years with no problem so um yeah about the risk of people huffing it ...

 

[Craig Alan Evans]

We have used it for close to 20 years now with great success.

 

[Galveston CFRN]

Low Tech solution to accidental crew inhalation of NO

I'm sure this isn't original, but it hasn't been mentioned.....
Crew in the back of the bus dons NRB or Simple O2 masks coming from onboard regulators....Common sense would yield increased FiO2 and dilution will prevent potential NO effect on caregivers in cabin. Combined with good cabin ventilation this should be enough to satisfy any OSHA concerns....this might work with extended contact as well (as in conscious sedation procedures in ED)....It deserves a second look, as Nitronox remains a useful and mostly harmless adjunct in EMS/ED analgesia and anxiolysis (apologies for spelling/grammar if incorrect). Glad to see that there are folks that still believe in this as a useful tool in the box!! Best Regards....Layne in Galveston, TX