Oxygen Administration

(Facts: An injured or ill person can benefit greatly from receiving air with a higher oxygen concentration.The air a person normally breathes contains approximately 21 percent oxygen. The concentration of oxygen delivered to a victim through rescue breathing is 16 percent.) Definition: In an effort to increase the fraction of inspired oxygen Concentration (FiO2) available to a patient, a variety of oxygen delivery Devices are employed to administer medical oxygen. The oxygen may be administered with or without humidity.

Emergency oxygen should be considered if

Indications
Hypoxemia Increased work of breathing Increased myocardial work Pulmonary hypertension Transport of patients on continuous oxygen therapy who are also being supplied continuous aerosol therapy; use of one of the devices described here eliminates the need for aerosolization during short term use

Contraindications
No absolute contraindications of oxygen therapy exist when indications are judged to be present. The relative contraindications of oxygen therapy relate to the dangers of hyperoxemia; the goal of oxygen therapy is to achieve adequate tissue oxygenation using the lowest possible FiO2.Although oxygen administration has inherent risks, the dangers of hypoxemia are greater.

Precautions/Hazards/Complications
Induced hypoventilation Oxygen toxicity may result from the long-term exposure to partially reduced oxygen products which alter the metabolic function and structure of lung cells. Patients who have received certain chemotherapeutic agents (i.e. bleomycin) may be particularly vulnerable to pulmonary toxicity with resulting fibrosis and/or emphysema. For further information on the effects of oxygen in the presence of potential pulmonary toxins Absorption atelectasis (high FiO2s) Drying of the nasal and pharyngeal mucosa Fire hazard Potentially inadequate flow resulting in a lower FiO2 delivery than intended due to a high inspiratory demand or an inappropriate oxygen delivery device Skin irritation from pressure exerted by the device or reactions to the materials of which the device is made Nasal obstruction, especially in infants and children Aspiration of vomitus may be more likely when a mask is in place. Vomitus may occlude the valve of a nonrebreather mask, thus decreasing oxygen delivery.

Adverse Reaction
When signs of hypoventilation (decreased level of consciousness in a suspected or known carbon dioxide retainer) are detected during oxygen administration, notify a physician, and obtain an order for arterial blood gas analysis. Confirmation of hypoventilation requires a decrease in the FiO2 and reassessment of ventilatory status after a short period of oxygen delivery at the lower FiO2 The decision to continue oxygen administration must be weighed against the physiological effects of hypoxemia on an individual basis. Hypoxemia greater than 98 percent, or PaO2 greater than 100 torr for an extended period of time) should be attended by an effort to decrease the FiO2.

Equipments
Oxygen Delivery Device Nasal cannula LPM 1-6 FiO2 .24-.44

Approx.4%/liter flow; FiO2 decreases as VE increases

 Simple mask

5-8

.35-.55

Approx. 4%/liter flow; minimum flow must be 5 LPM to flush CO2 from mask.

Venturi mask

Variable

.24-.50

See pkg. insert for precise flow and corresponding FiO2

Partial rebreather 6-10 .50-.70 Flow must be sufficient to keep reservoir bag from deflating upon inspiration

Nonrebreather 6-10 . 70-1.0 Flow must be sufficient to keep reservoir bag from deflating upon inspiration

Take the following precautions when using oxygen: Always make sure that oxygen is flowing before placing the delivery device over the victims mouth and nose. Do not use oxygen around flames or sparks. Oxygen causes fire to burn more rapidly. Do not smoke or let anyone else smoke around oxygen in transport, in use or on standby. Do not use grease, oil or petroleum products to lubricate or clean the pressure regulator or any fitting hoses, etc. This could cause an explosion. Do not stand oxygen cylinders upright unless they are well secured. If the cylinder falls, the regulator or valve could become damaged or cause injury. Do not drag or roll cylinders. Do not hold onto protective valve caps or guards when moving or lifting cylinders. Do not deface, alter or remove any labeling or markings on the oxygen cylinder. Do not attempt to mix gases in an oxygen cylinder or transfer oxygen from one cylinder to another. Never use oxygen without a safe regulator that fits properly. When the tank is not in use keep valves closed even if the tank is empty. Store oxygen tanks below 125F. If defibrillating, make sure that no one is touching or is in contact with the victim or the resuscitation equipment. Do not defibrillate someone when around flammable materials, such as gasoline or freeflowing oxygen. Never drag or roll cylinders. Carry a cylinder by both hands and never by the valve or regulator. Do not store oxygen cylinders near flammables or hot water heaters, near electric or phone boxes, where they can have something heavy fall on them, where they could be tipped over or exposed to heat or direct sunlight. When transporting oxygen cylinders: do not store them in the trunk; secure then in case of a sudden stop, acceleration or sharp turn, when they could become a serious projectile hazard; immediately remove them from the vehiole rather than risk heat exposure which could cause a potentially hazardous release of gas. ______________________________________ Regularly check for cylinder leaks, bulging, and defective valves. Also check for rust or corrosion on the cylinder or cylinder neck or regulator assembly. No adhesive tape should be put around the cylider neck, oxygen vale or regulator assembly as it can hamper oxygen delivery and might also have the potential to cause a fire or explosio