Under extreme conditions, ambulance attendants and drivers could be exposed to nitrous oxide administered to transported patients in concentrations causing acute effects. Special arrangements are necessary to prevent such exposure, which is influenced by travelling speed, local exhaust ventilation and the use of an excess gas transfer tube evacuating expired air and overflow gas from the face mask to the outside. The separate eliminative effects of travelling speed and local exhaust varied considerably with the experimental conditions. The excess gas transfer tube reduced the levels of nitrous oxide in the air by 86 to 97% inside the ambulance at different experimental conditions. The combination of excess gas transfer tube and local exhaust resulted in a relatively constant reduction of the airborne nitrous oxide levels by about 98% when the ambulance was at a standstill and 99% when it was running.
Pre-hospital self-administered analgesia using a 50:50 mixture of nitrous oxide and oxygen (Entonox) was evaluated in 240 patients. Of these, 93.4 per cent experienced either complete or partial relief from traumatic, chest, abdominal or back pain. Drowsiness was the most common side effect noted. No complications occurred during delivery of the mixture. Attention is drawn to the effect of extreme temperatures on the Entonox mixture and recommendations are made with respect to its use in below-freezing climates. Because of its ease of use and short duration of action, Entonox appears to be well suited for the treatment of pre-hospital pain by Emergency Medical Technicians.
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