Sunday, October 01, 2006

Oxygen Wars

CD in Play: Various, Minimalist.

Without naming names, etc. I seem to be in a bit of a battle with my co-workers over the issue of administering oxygen to a student. Said student suffers from cluster headaches, a debilitating condition said by some to more painful than migraines or childbirth - like an ice pick continuously stabbing you in the eye or as the wikipedia entry puts it - "It has been reported as the most severe pain known to medical science, worse than amputation without anesthetics".
One thing that many sufferers gain relief from is oxygen inhalation. If started within 5 minutes of first appearance of symptoms and taken for 10-20 minutes at 6L-7L per minute (Lpm here after) it has the chance of preventing the headache from occuring. Naturally, I believe we should be giving said student oxygen therapy everytime said student has an attack, right? Um... well no and this is the source of the conflict.
My younger co-workers believe we ought to apply O2 everytime an attack occurs. However, cluster headaches are called such because they come in cluster cycles of 1-8 attacks a day for 1-3 months 2 times a year. That's a lot of O2 to use on one person. And then there is the argument about flow rate. The BC Health Guide says 6-7Lpm for 10-20 minutes. One cluster headache support group advocates a flow of 8Lpm for 10-20 minutes. Some attendants on site want to appease the student by administering the standard 10Lpm that we would administer to someone suffering with something like angina, a full-on myocardial infarction, blow trauma, etc. Then there is the student and the student's significant other who are demanding it be set to 15Lpm. The temporary policy is 8Lpm for 10 minutes, if no relief is had at that time we are to shut the valve off.
Some attendants are prepared to acquiesce to the student's demands no matter what, stating that it is our job to alleviate their horrible suffering. I have openly said that we can longer give the student any oxygen. Cluster headaches are often referred to as "suicide headaches" because of the pain, but are not known to be lethal in and of themsleves as far as my reading has gone. My job as a first aid attendent is not to alleviate pain so much as it is to intervene in a traumatic incident and prevent further damage from occuring. First Aid Attendents are the front line in care, they help to increase a patients chance of survival so that more qualified people can go in a nd finish the job. We do not take away pain, otherwise we would be allowed to dispense medication, including basic over the counter drugs like acetylsalicylic acid, acetaminophen and ibuprofen.
Put it to you this way, if the student has one attack on campus a day and we admister 8Lpm O2 for 10 minutes we should be out of O2 in 6 days. At 10Lpm we run out of O2 in 4.8 days. If we do what the student demands - 15Lpm - we run out in 3.2 days. So this goes on for 1-3 months in which time both tanks get depleted. My co-workers' answer to this is simple - we borrow the tanks from the Mall and the Tower. While the Tower never seems to have used their tanks, that doesn't mean they may never need to use it. Same goes for the mall. Besides Tower and Mall management aren't going to like shelling out their money to have someone else use up their oxygen bought for their own use. (if you empty a cylinder you have an additional charge for hydrostatic testing)
How many other students, staff or faculty suffer from cluster headaches? Do they all get oxygen? What about people suffering from chronic conditions? How many are diabetics? How many have heart conditions? Are they aware of their maladies? Have they ever sustained injuries in the past that make them suceptable to further injuries or physical problems? Granted O2 is often used in calls where there is no apparent respiratory or cardial distress - such as a fall, or a blow - but one hopes that it isn't something that will re-occur everyday with the same person.
Now that I have mentioned all this, I will mention that I learned the student has their own O2 tank at home but finds the paper work to be a huge hassle. Sort of a cop out, especially given the pain said student is going through. However, I just learned that O2 is classified as a hazardous substance (I know, I know... but we are taking about compressed O2 here) so tranporting it to and from school may require permits. Storage is another problem as it cannot just simply be stored in a locker. Someone stated she could store it in First Aid or Security, but that may get into issues of liability and access. Also, what happens if we end up using that tank because we have to?
Still, I find it presumptuous and self-centred of the student to presume that we ought to supply the oxygen because it is more convenient for them. But the student is only about 19 and the co-workers who are adamant about giving-in to the student are 25 and under. Maybe age is the reason for my intransigence? Perhaps it is the repeated lessons that life really so often is suffering, at least it is a key component. Suffering is terrible but inescapable and sometimes there really is nothing you can do for an individual's suffering. Especially if it potentially puts the well-being of others in the balance.


Blogger Geosomin said...'s odd, but I wonder why the person doesn't have their own O2? If I had headaches that bad (thankfully I ondly get severe migranes a few times a year) I woul. I'd work it out. Sure the paperwork is a PITA but I've done it for labs and it can be done. I'm sure she could work out something with the school if she wanted to...she just deosn't have to and is a bit too young to realise she should. It's an entitlement thing...sort of.
Me? I wouldn't trust the school to have O2 for me...after a while you wouldn't anyways and then someone who needed it to live would be screwed over in the name of what is really convenience. I mean I wouldn't wish those headaches on anyone, but she's gotta learn to live with them. Stick to you guns and don't feel badly about what you're doing. You guys aren't her are there to help keep them alive. Agony is still being alive. She should be able to work this out for herself. You're a good person.

01 October, 2006 14:20  
Blogger Magnus said...

Interesting assumption about the sex of said student.
I suffer from migraines same as you do, (damn genetics) and having encountered people who suffer from cluster headaches I really do feel bad about the pain the student has to endure. However, I don't feel about about sticking to my guns on this one as I would feel worse id we didn't have oxygen in a stuation that was a matter of life and death.
I do get the impression that said student is a tad spoiled and has a kind of "royal perogative" complex.
There is going to be an Occupational Health and Safety meeting on Monday and I fully expect that their decision will back me up.
Excessive pure oxygen, as I am sure my friends are aware, can actually be bad for people with prolonged use. The student expects a 15Lpm flow and has already sucked back one tank - 45 minutes worth of oxygen - in one sitting. I believe the student may have been incorrectly informed about oxygen therapy. If this is typical of their usage, they could be doing harm to their respiratory system.
Not that I am a doctor, of course.

02 October, 2006 00:46  
Blogger Magnus said...

Thanks for the compliment, btw.

02 October, 2006 00:48  
Blogger RC said...

very interesting, i've never heard of cluster headaches or the thought of administering O2 for headaches.

Thanks for this post.

--RC of

02 October, 2006 23:43  
Blogger Geosomin said...

I think the student is falling prey to the "more is better" with the oxygen flow. It really could damage your system at levels that high - I remember before my grandpa passed away he was given too high of oxygen by the nurses in an attempt to help him breathe better - all it did was hurt his lungs and make him hallucinate and think my Mom was trying to kill him (which if you've met my Mom is pretty funny - she's 5 feet tall and maybe 100 pounds soakin wet and wouldn't hurt a fly if it bit her). Many of the prescription OD we see here at the hospital is from people falling for the more is better and "it's not working I'd better take more" thing...people forget that medicine and treatments can eb taken too far.

As for the gender thing, I don't really know how I got a she out of it. Maybe I just figure a guy would be more likely to fill out the paperwork...hmmm...look at me and my predispositions...

04 October, 2006 08:54  
Blogger Magnus said...

I figured it was the more is better thnig as well. Though some of the support groups advocate 15Lpm as well. It has all been hammered out - some hard feelings but not by the student who is quite pleasant with me.

04 October, 2006 20:45  

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