Nitrous oxide (chemical formula: N₂O) is also known as nitrous, nos or more colloquially, “laughing gas”. It is an oxide of nitrogen and a colourless gas with a slightly sweet odour and taste.
Nitroud oxide is used as an anaesthetic, in rocket motors, in racing vehicle engines and as an aerosol propellant.
It has been used as a mild general anaesthetic since the mid 1800s to relieve pain in instances of dental surgeries and childbirth to name a few.
Food safe nitrous oxide also has use in food preparation as an aerosol propellant. It is used in canned whipped creams and cooking sprays.
Nitrous oxide is also abused recreationally for its hallucinogenic and euphoric effects, paired with that fact it is also widely available and easy to obtain.
The routes of exposure for nitrous include; inhalation and skin and eye contact. Ingestion is not considered likely due to the gaseous state of the chemical.
Inhalation of nitrous oxide may cause inflammation and irritation of the respiratory system. Symptoms common with inhalation include; headache, confusion, dizziness, coma, seizures, circulatory collapse, nausea, vomiting, euphoria, depression, sleepiness, loss of coordination as well as others. Nitrous oxide is highly volatile and the vapour may displace and replace breathing air, acting as an asphyxiant. Inhalation of small amounts often produce a state of euphoria in individuals whereas larger amounts produce an anaesthetic effect.
When exposed to skin, it can produce irritation, inflammation, redness, swelling, blistering and scaling. It may also worsen any pre-existing dermatitis conditions. Entry into the bloodstream through open cuts and wounds may also lead to other harmful effects.
It is expected that eye contact with nitrous oxide may cause severe ocular lesions that can remain for at least a day after the exposure. Direct eye contact may not cause irritation because of the volatility of the gas, but concentrated exposures may produce irritation.
If inhaled, remove the patient from the contaminated area to the nearest fresh air source. Keep the patient warm and rested. If the patient is not breathing and you are qualified to do so, perform CPR, preferably with a bag-valve mask device. Transport to hospital without delay.
If swallowed, seek medical attention without delay as urgent hospital treatment is likely to be needed. Induce vomiting if medical attention is more than 15 minutes away, with fingers down the back of the throat. Lean the patient forward or placed on their left side to maintain open airways and prevent aspiration.
If skin exposure occurs, immediately remove all contaminated clothing and footwear and flush the affected area with plenty of running water and soap. Seek medical attention in the event of irritation.
If the chemical is exposed to the eyes, remove the patient from the contaminated area and take to the nearest eye wash station or emergency shower. Open the eyelids wide to allow the chemical to evaporate. Flush the eyes out with fresh running water for at least 15 minutes, remembering to wash under the eyelids. Removal of contact lenses should only be done by a skilled individual. Transport to hospital.
Emergency eyewash fountains and safety showers should be accessible in the immediate area of the potential exposure to the chemical. There should always be adequate ventilation to remove or dilute any air contaminants (install local exhaust if necessary).
The PPE recommended when handling nitrous oxide includes; safety glasses with side shields, chemical goggles, overalls, PVC aprons/protective suits, full face respirators, gloves and safety boots.
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