OXYGEN (O2)
ACTION
Oxygen is essential for cell metabolism and normal physiological function.
CAN BE ADMINISTERED BY
ƒ
ƒ
Members with a current Medical Gases or Ambulance Aid qualification
Appropriately qualified Healthcare Professionals who are competent in the clinical
use of oxygen
INDICATIONS
The beneficial effects of oxygen cannot be overstated. Its therapeutic use reverses the
adverse effects of hypoxaemia (shortage of oxygen the blood) on the brain, heart and other
vital organs.
OXYGEN SHOULD BE USED IN ALL CONDITIONS WHERE HYPOXIA (A LACK OF OXYGEN) MAY BE PRESENT
e.g.
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Cardiac or respiratory arrest
Airway obstruction
Shortness of breath or respiratory distress (including Chronic Obstructive Pulmonary
Disease [COPD] and acute asthma attack)
Chest trauma
Shock (all causes)
Chest pain
Circulatory compromise (e.g. haemorrhage)
Sudden or unexplained loss of consciousness / neurological deficit
Stroke
Significant trauma including head injury
Collapse
Coma (from any cause)
Repeated seizures
Near drowning
Toxic inhalations (smoke, chemicals, carbon monoxide)
Any casualty in a critical condition
CONTRA-INDICATIONS
Paraquat poisoning
CAUTION
Oxygen may cause a problem in patients with a diagnosis of ‘Chronic Obstructive Pulmonary
Disease’ (COPD) such as emphysema or chronic bronchitis.
The normal stimulant for breathing is an increase in carbon dioxide levels in the blood, some
patients with COPD (those with permanently high carbon dioxide levels) instead depend on
a decrease in oxygen levels in the blood to stimulate breathing, and therefore giving large
amounts of oxygen may cause these patients to stop breathing altogether.
Despite this caution all patients showing signs of a lack of oxygen, including those with
COPD, should be given high concentrations of oxygen initially.
HYPOXAEMIA (lack of oxygen) WILL KILL A PATIENT FAR QUICKER THAN OXYGEN
THERAPY
SIDE EFFECTS
Usually none
HQC 87/06e
OXYGEN - Appendix E
1
In patients with COPD who rely upon hypoxic drive for breathing there is a small risk that
high-flow oxygen may cause respiratory depression (low rate of breathing) and/or
respiratory arrest.
DOSE AND ADMINISTRATION
It is important to administer the correct oxygen concentration/flow rate for the patient’s
condition.
When delivering oxygen therapy consider the following three points:
ƒ
The flow rate
ƒ
The face mask and delivery system
ƒ
Careful patient monitoring
Medium to high flow oxygen should be used in ALL emergency situations. This can be
achieved in most cases by the use of 40-60% oxygen via a standard medium concentration
mask.
The percentage of oxygen delivered to the patient is determined by the choice of mask and
flow rate.
High-flow oxygen should be administered using a face mask with a reservoir bag.
This is the preferred type of mask for severely hypoxic and major trauma patients.
To function effectively it is essential to ensure the reservoir bag is filled before use and that
a sufficient oxygen flow rate is maintained to keep the reservoir bag fully inflated.
For patients with known COPD it is not desirable to exceed an oxygen saturation of 93%
(where oxygen saturation monitoring is available). In these cases oxygen therapy should be
stated at approximately 40% (4-6 litres/minute for most brands of medium concentration
mask) and titrated upwards if the oxygen saturation decreases below 90% and downwards
if the patient becomes drowsy and/or the oxygen saturation exceeds 93-94%.
Controlled oxygen therapy (24-28%), if required, should be administered using a Venturi
mask with the flow rate set accordingly (approximately 4-6 litres per minute).
Note that some patients will have special requirements for the delivery of oxygen. For
example, laryngectomy and tracheostomy patients will need oxygen delivered via their
stoma, rather than via mouth or nose. If special masks are not available a standard mask
turned sideways over the opening may be used to good effect.
O2 Delivery Systems:
1. Venturi mask
2. Medium concentration mask
(Hudson face mask)
3. Face mask with reservoir bag
4. Nasal prongs
HQC 87/06e
OXYGEN - Appendix E
2
PRESENTATION
Oxygen is a colourless odourless gas normally present in the atmosphere at a concentration
of 21%.
Oxygen for therapeutic use is traditionally stored in medical cylinders that have a black body
with white shoulders (UK). Newer lightweight cylinders may not follow this convention.
Standard
Cylinder
Light weight
Cylinder
SAFETY PRECAUTIONS
Oxygen increases the fire hazard at the scene of an accident
When a shock is given from a defibrillator, ensure oxygen is at least one metre away
from the casualty
Never smoke when oxygen is being used
The following precautions should always be taken when handling oxygen cylinders:
ƒ Never allow combustible materials such as oil or grease to come into contact with the
cylinder, regulator, fittings, valves or hoses
ƒ Never smoke in any area where oxygen cylinders are in use or on standby
ƒ The oxygen cylinder should not be subjected to temperatures above 50°C
ƒ Oxygen cylinders should be secured to prevent them toppling over
ƒ All valves should be closed when the cylinder is not in use; even if the tank is empty
ƒ When administering oxygen always position yourself to the side of the cylinder. Never
place any part of your body over the cylinder valve
MAINTENANCE
Regular checks should be made on the oxygen cylinder to ensure there is sufficient oxygen
contained should it be required for use. It is wise to hold a back up cylinder in case of
prolonged resuscitation or usage.
All valves should be closed off after use.
Cylinders and ancillary equipment should be stored according to the manufactures
guidelines.
HQC 87/06e
OXYGEN - Appendix E
3