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Medical gases and what are they? We need to just have a little bit of an understanding of what medical gases are and what you are potentially going to be using in the prehospital world. There are two main medical gases that we use, one is oxygen, one is Entonox. Entonox is a blue cylinder with a blue and white segmented neck. It is a pain-relieving gas, but we have to understand that it is a mixed nitrous oxide and oxygen. It is used for things like mild pain, sprains, strains, childbirth, but it is also used for chest pain and cardiac pain.

The thing about medical gases, we have to understand how they work, and especially with Nitronox or Entonox, the two gases actually separate, especially under cold temperatures. So, the first thing we have to remember is the two gases must be mixed before we actually use the gas. So the way we normally mix the gases is by inverting or turning the bottle upside down two or three times to actually shake the contents so the two gases mix together, so when we administer the gas it is what we are actually expecting. We have not allowed the gases to separate and we are only giving oxygen or nitrous oxide. So remember that first of all.

Oxygen is just one gas, so there is no mixing process required in oxygen itself. It is a sterile, pure, clean gas. So it is not the air we are breathing. It is not the same sort of stuff that welders and people like that use. It is pure, clean, medical oxygen. The reason you will find stickers on cylinders is because it has a use-by date. It is sterile, it is manufactured to be pure. So when we give it, we have to be careful how we give it, who we give it to and use it sparingly, use it carefully on the correct patients, and you will find that out as we go through the course. But the most important thing to understand is, these are medical gases, they are drugs. Oxygen used to be a prescription-only drug. Oxygen now is pretty well available to most people in the first response world, because the benefits of oxygen to a patient in cardiac arrest and situations where they have got breathing problems are immense, it is a very valuable asset in your toolkit.

Entonox may be available to you, it may not. All services, all different response departments will have different protocols and different things that you are allowed to use, but Entonox now is a common drug used by first responders. It is on all ambulance crews, but it is also now used in mountain rescue and a lot of other emergency services use it because it is a very efficient, very effective, simple-to-use, self-applicated drug in the relief of pain. Self-applicated basically meaning the patient gives it to themselves. They take the dosage they require until the pain eases and when the pain eases, they normally start to go a little bit woozy, a little bit light-headed. The nitrous oxide mouthpiece or face mask comes away from their mouth and they stop administering it to themselves. So they are self-administered, under supervision, safe, effective, efficient drugs. But we have to remember they are drugs, so we have to be careful. We have to give them to correct patients and our primary surveys and secondary surveys are important in deciding whether we are going to give a drug, which drug it is going to be and how we are going to actually administer it.

So remember, medical drugs, need to know about them, need to understand them, need to know when they are to be used and when they are not. Certain drugs will have contraindications. Oxygen, for instance, paraquat, a poison that is not very often used anymore; however, oxygen makes paraquat more toxic, so you are actually making the patient worse. So we need to look at the rules and regulations, we need to understand what it does, how it works, how it interacts with other things before we start administering it. We will do that as the course goes on.