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Greenville County EMS

Nitrous Oxide Administration

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Why are piloting:

  • We became a tiered response system in late 2019
  • Pain management is a common reason BLS units call for ALS back up.
  • By piloting this we are expediting patient’s pain management and avoiding delays to definitive care

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Benefits to Patients

  • Decreases the time required to manage patient’s pain.
  • By managing the pain BLS providers can expedite transport to definitive care.

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About Nitrous Oxide

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  • Class: Gas
  • Action: CNS depressant
  • Indication: Pain of musculoskeletal origin, particular fractures, burns, suspected ischemic chest pain, states of sever anxiety, including hyperventilation
  • Contraindications
    • Use with caution in patients with head trauma, increased ICP, pneumothorax, or suspected bowel obstructions
    • Use with caution with patients with COPD as this may impair their hypoxic drive

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About Nitrous Oxide (cont.)

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  • Side effects: headache, dizziness, giddiness, nausea, vomiting
  • Dosage: self-administered only using commercial blender
  • Route: Inhalation only
  • Pharmacokinetics
    • Onset 2-5 minutes
    • Peak effect: 2-5 minutes
    • Duration: 2-5 minutes

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Administration system

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Administration system

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Administration system

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Administration system

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Administration Clinical Guideline

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Pain management guideline

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Checklist use

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Documentation Requirements

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  • VITALS Page
  • Pain scale Must be documented
    • Before administration
    • After administration
    • At transfer of care

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Documentation Requirements

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  • Flowchart

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Documentation Requirements

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  • Flowchart

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Documentation Requirements

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  • Flow Chart

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Documentation Requirements

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  • Your narrative should follow your normal flow. Please make sure in incudes the indication for nitrous administration, patient’s level of consciousness before and after administration and the effects the administration had on the patient.

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Documentation Requirements

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Reference list

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  • Bledsoe, B. E., & Clayden, D. E. (2019). Prehospital emergency pharmacology. NY, NY: Pearson.
  • Smarter Decisions. Better Care. (2020, April 07). Retrieved August 02, 2020, from https://www.uptodate.com/home

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Thank you for your time