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I know we've visited this a few times before, but I had a classic the other night: 80 year old non-specifically unwell referred by GP (I am a medic at the moment) bit of a non-productive cough lifelong non-smoker. When s/b HO in A&E the relatives were saying that her speech had gone all funny and she had become very sleepy while the ambulance crew were packaging her within minutes of starting O2. HO asked me to see her -- very drowsy, some appropriate responses to questions but disorientated, resps 10 sats mid 90s, puffing away on 2 litres only. ABGs: pO2 16 pCO2 14 pH about 7.2 took the O2 off and 15 minutes later, fully alert and orientated chatting away. I'd never seen narcosis come on or go off that quickly. Re-inforces the "100% O2 isn't right for everyone" argument, particularly if transport times are long -- although not in this case, notwithstanding those who are retaining but you have to give O2 anyway before they die from hypoxia (had one of those last night too). -- Sam Waddy Medical SHO