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I am an NREMT-P working as Head of Paramedics at the International Medical Center in Jeddah,KSA. I would like to have your opinion on having to place an IV Paracetamol preparation known as Perfalgan which is the only form of Paracetamol available for IV use in our EMS Drug Bags. I am working on our pre hospital care protocols with our Medical Director but would like to post this for discussion and see if this would be a favorable drug to be placed in our EMS Bags knowing that it can be used for both Anti-Pyretic/Anti-Inflammatory affects. It has also been used to control moderate to certain degrees of severe post operative pain. Your opinions will be highly appreciated. Big Moe

This is a very interesting subject. Even though, I would have to say that this patient might have developed another problem with his CO Poisoning. The reason is becuase he improved after placing CPAP. I would have appreciated more information in regard to his physical examination and what it revlead in terms of Lung Sounds. Some people develope what is called HAPE (High Altitude Pulmonary Edema) and in his case, I am not really sure but lung sounds would make a difference. Giving the fact, that CPAP does not work or affect the pressure of inspired oxygen. It only gives a constant pressure that will keep the Alveoli Open and creates more surface area for adeqaute gas exchange. It has no affect on displacing Carbon Monoxide off the Hemoglobin Molecules and that's why Hyperbaric Chamber is the Gold Standard of treating such conditions. The fact that his SPO2 level was low, brings another concern about the available gas for exchange. I mean that if this patient did not have any problem affecting gas exchange at the alveolar level, then SPO2 readings should not be affected. Mild, Moderate or Sever cases of Co Poisoning would have not affected SPO2 readings, as the Pulse Oximeter reads how well the HG Molecules are saturated but regardless of the tyoe of molecule that is being carried. I do not want to rely on SPO2 only, again I was not there and the patient could have been mildly hypothermic and this is why SPO2 was low. I do not know, I am only giving all my thoughts, so I make sure I did not leave a possibility. If the Pt. Temp was fine, I would sort of lean toward a possible perfusion problem at the alveolar level. This brings another question to the table, Does CO poisoning play a role in developing mild Pulmonary Edema? Does it have any affect on Capillary Permiability? There was an interesting study done about CO Poisoning and Developing Mild Left Ventricular Dysfunction. This study concluded that moderate to severe cases of CO Exposure could cause LVD without the presence of any previous history of Cardiac Diseases. Could a mild LVD in this case,have been a contribute cause of the Low Spo2 reading, keeping in mind that LOW SPO2 means neither the CO nor the Oxygen is being saturated very well as a possible casue of inadequate gas exchange at the alveolar - capillary level? I am not really sure but it is a certain possibility. Again, thank you for sharing this with us. It is very interesting, and sure opening our minds to many possibilities.

Ok, M Tanks will have a CGA Female Port that is compatible with CGA 540. In this case, you will have to have a rubber gasket or if finding a rubber gasket is an issue then Teflon Tape will do (as one of the member mentioned above), it does really help and work as a gasket. I do not have gaskets on our O2 cylinders and have been using Teflon Tape for quiet a long time now and never encountered a problem.

May I ask what type of cylinders you are using in terms of capacity and size? Although, most O2 cylinders under the same amount of pressure which is about 2015 psi, still the size of cylinder plays a major role in the type of regulator you can install and therefore I could help you more in answering your question. E, D, Jumbo D O2 cylinders mostly use the Brass Yoke Style or click style CGA 870 Regulator. For this type of regulators you would need the WASHERS, otherwise you will get a leak. Large Cylinders such as M, H, or K use other types of regulators that are completely different in their fitting styles. They use a fitting type called CGA 540 and they come in Brass or in single or two stage preset regulators to 50psi. If you are