OXYGEN ADMINISTRATION

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OXYGEN ADMINISTRATION

• Ashland Community
• and Technical College
• Presented by Bob Chaffins

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Introduction

• Oxygen therapy is perhaps one of the most
  important and beneficial treatments a first
  responder can provide.
• Although the atmosphere provides 21 oxygen which
  is sufficient for life, many of the people you
  deal with are sick or injured and often require
  supplemental oxygen.

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Topics of Discussion

• Conditions which may require oxygen.
• Vocabulary
• Hazards of Oxygen Therapy
• Oxygen Therapy Equipment
• Oxygen Equipment Safety
• Delivering Oxygen

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Overview

• Within 10 minutes of non-breathing, the patient
  will suffer irreparable brain damage and other
  vital organs will shut down.

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Brain
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Key Points

• The air that a person normally breathes contains
  21 oxygen.
• During rescue breathing, the oxygen concentration
  that the victim receives is 16 with a
  resuscitation mask and 21 with a BVM.
• An injured or ill victim CAN BENEFIT GREATLY from
  a higher oxygen concentration.

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Key Points

• You deliver a higher concentration of oxygen when
  you administer supplemental oxygen.
• To deliver supplemental oxygen you need
• An oxygen cylinder
• A pressure regulator
• A delivery device (mask, cannula, etc.)

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Vocabulary

• Hypoxia an insufficiency in the supply of
  Oxygen to the bodys tissues.
• Airway adjunct a device placed in a patients
  mouth or nose in order to help maintain an open
  airway.
• Bag-valve mask (BVM) a hand-held unit with
  self-refilling bag, directional valve system, and
  face mask used to deliver 100 Oxygen.

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Vocabulary

• Barrier device a device such as a pocket face
  mask, face shield, BVM, disposable gloves, or
  goggles that prevent direct contact with a
  patient or the patients breath or body fluids.
• Chronic Obstructive Pulmonary Disease (COPD) a
  group of lung diseases and conditions including
  emphysema, chronic bronchitis, and black lung.

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Vocabulary

• Face shield a thin, transparent barrier device
  that protects against direct contact with the
  patient during artificial ventilations.
• Flow-meter a valve that indicates the flow of
  oxygen in liters per minute.
• Humidifier a device connected to the flow-meter
  to add moisture to the dry oxygen coming from the
  cylinder.

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Vocabulary

• Hypoxia an inadequate supply of oxygen reaching
  the bodys tissues.
• Hypoxic drive a condition common to COPD
  patients in which the body determines the need to
  breathe based on oxygen rather than carbon
  dioxide and may interpret the higher oxygen
  levels that result from oxygen administration as
  a signal to reduce or stop breathing.

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Vocabulary

• Nasal cannula a device that delivers low
  concentrations of oxygen through two prongs that
  rest in the patients nostrils.
• Nasopharyngeal airway (FYI) a flexible breathing
  tube inserted through the patients nose into the
  pharynx.
• Non-rebreather mask a face mask and reservoir
  bag device that delivers high concentration
  oxygen. All of the patients exhaled air is
  exited and not re-breathed.

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Vocabulary

• Oropharyngeal airway (FYI) a curved airway
  adjuct inserted through the patients mouth into
  the pharynx.
• Oxygen cylinder a cylinder filled with oxygen
  under HIGH pressure.
• Partial re-breather mask a face mask and
  reservoir bag device that delivers high
  concentration oxygen. Part of the exhaled air is
  re-breathed.

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Vocabulary

• Pocket face mask a device with a one-way valve
  to aid in mouth-to-mouth resuscitation. It can
  be used with supplemental oxygen when fitted with
  a oxygen inlet.
• Pressure regulator a device connected to an
  oxygen cylinder to reduce cylinder pressure to a
  safe pressure for delivery of oxygen to a patient.

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Vocabulary

• Simple face mask a soft mask through which
  moderate concentrations of oxygen can be
  delivered.
• Suction unit a device that is used to remove
  blood, secretions, or other fluids from a
  patients mouth, throat, or stomach.
• Venturi mask a mask that delivers consistently
  regulated low concentrations of oxygen.

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Conditions Which Require Oxygen Therapy

• Respiratory or Cardiac Arrest CPR is only 25 to
  33 efficient. High-concentration oxygen
  provides a better chance of survival for the
  patient in respiratory or cardiac arrest.
• Heart Attacks and Strokes these emergencies
  result from an interruption of blood to the heart
  or brain, tissues are deprived of oxygen and
  makes O2 therapy critical.

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Conditions Which Require Oxygen Therapy

• Shock since shock is the failure of the
  cardiovascular system to provide sufficient blood
  to all the vital tissues, all cases of shock
  reduce the amount of oxygenated blood reaching
  the tissues. O2 therapy helps the blood that
  does reach the tissues deliver the maximum amount
  of oxygen.

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Conditions Which Require Oxygen Therapy

• Blood Loss whether bleeding is internal or
  external, there is a reduced amount of
  circulating blood and red blood cells, so the
  blood that is circulating needs to be saturated
  with oxygen.
• Lung Diseases the lungs are responsible for
  turning oxygen over to our blood cells to be
  delivered to the tissues. When the lungs are not
  functioning properly, supplemental oxygen becomes
  critical.

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Conditions Which Require Oxygen Therapy

• Broken Bones, Head Injuries, and More there are
  very few emergencies where oxygen administration
  would not be appropriate. All our bodys systems
  work together. An injury in one part may cause
  shock that affects the rest of the body.

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Conditions Which Require Oxygen Therapy

• Hypoxia there are many causes of hypoxia
  including breathing difficulties or injury,
  stroke, shock, and others. Hypoxia may be
  characterized by a blue or gray color to the skin
  (cyanosis). When the brain suffers hypoxia, the
  patients level of consciousness (LOC) may
  deteriorate. Restlessness or confusion may
  result.

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Hazards of Oxygen Therapy

• Oxygen used in emergency care is stored under
  pressure, usually 2000-2200 psi. If the tank is
  punctured, or a valve breaks off, the supply tank
  can become a missile (can penetrate a concrete
  wall).
• Oxygen supports combustion, causing fire to burn
  more rapidly. It can saturate towels, sheets,
  and clothing, greatly increasing the risk of fire.

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Hazards of Oxygen Therapy

• Under pressure, oil and oxygen DO NOT mix. When
  they come into contact, a severe reaction occurs
  which is termed an explosion. DO NOT lubricate a
  delivery system or gauge with petroleum products,
  or allow contact with a petroleum-based adhesive
  (ie. Adhesive tape).

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Hazards of Oxygen Therapy

• RULE the benefits of oxygen far exceed the
  medical or non-medical hazards. NEVER withhold
  oxygen from a patient who really needs it.

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Oxygen Therapy Equipment

• Oxygen cylinders
• Fixed
• Portable
• Pressure regulators
• Delivery device
• Face mask
• Cannula

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Oxygen Therapy Equipment

• Oxygen cylinder a seamless steel or lightweight
  allow cylinder filled with oxygen under pressure,
  equal to 2000-2200 psi when full.
• Fixed
• Portable

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Oxygen Therapy Equipment

• Portable cylinders come in various sizes
• D cylinder contains approx. 350 liters
• E cylinder contains approx. 625 liters
• M cylinder contains approx. 3000 liters
• Fixed cylinders come in various sizes
• G cylinder contains approx. 5300 liters
• H cylinder contains approx. 6900 liters

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Oxygen Therapy Equipment

• The United States Pharmacopoeia (USP) has
  assigned a color code to distinguish compressed
  gases.
• Light Green and white cylinders have been
  assigned to all grades of oxygen.
• Unpainted stainless steel and aluminum cylinders
  are also used.
• Always make sure you are always using medical
  grade oxygen (USP designated).

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Oxygen Therapy Equipment

• Make sure that you always maintain a safe
  residual for an oxygen cylinder.
• SAFE RESIDUAL for an oxygen cylinder is a minimum
  of 200 psi.
• Below this point, there is not enough oxygen for
  proper delivery to a patient.
• Before the cylinder pressure reaches 200 psi, you
  must switch to a fresh cylinder.

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Oxygen Equipment Safety

• NEVER drop a cylinder or let if fall against any
  object. When moving a patient with an oxygen
  cylinder, make sure the oxygen cylinder is
  strapped to the stretcher or otherwise secured.
• NEVER leave an oxygen cylinder standing in an
  upright position without being secured.

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Oxygen Equipment Safety

• NEVER allow smoking around oxygen equipment in
  use. Clearly mark the area of use with signs
  that read OXYGEN NO SMOKING.
• NEVER use oxygen around an open flame.
• NEVER use grease, oil, or fat-based soaps on
  devices that will be attached to an oxygen supply
  cylinder. Do not handle these devices with greasy
  hands.

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Oxygen Equipment Safety

• NEVER use adhesive tape to protect an oxygen tank
  outlet or to mark or label any oxygen cylinders
  or oxygen delivery apparatus. The oxygen can
  react with the adhesive and debris and cause a
  fire.
• NEVER try to move an oxygen cylinder by dragging
  it or rolling it on its side or bottom.
• NEVER use the gauges as a handle to move an
  oxygen cylinder.

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Oxygen Equipment Safety

• ALWAYS use the pressure gauges, regulators, and
  tubing that are intended for use with oxygen.
• ALWAYS use non ferrous metal oxygen wrenches for
  changing gauges and regulators or for adjusting
  flow rates. Other types of metal tools may
  produce a spark should they strike against metal
  objects.

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Oxygen Equipment Safety

• ALWAYS ensure that valve seat inserts and gaskets
  are in good condition. This prevents dangerous
  leaks. Gaskets on D and E oxygen cylinders
  should be replaced each time a cylinder change is
  made.
• ALWAYS use medical grade oxygen. The cylinder
  should be labeled OXYGEN U.S.P. The oxygen
  must not be more than 5 years old.

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Oxygen Equipment Safety

• ALWAYS open the valve of an oxygen cylinder
  fully, then close it half a turn to prevent
  someone else from thinking the valve is closed
  and trying to force it open. The valve does not
  have to be fully open for delivery.
• ALWAYS store reserve oxygen cylinders in a cool,
  ventilated room, properly SECURED in place.

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Oxygen Equipment Safety

• ALWAYS have oxygen cylinders hydrostatically
  tested EVERY 5 YEARS. The date a cylinder was
  last tested is stamped on the cylinder. Some
  cylinders can be tested every 10 years. These
  will have a star after the date (e.g. 4M86)

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Oxygen Delivery

• Nasal Cannula
• Good delivery device
• 4-6 liters/min
• 24-44 Oxygen delivered
• Used for patients who cannot tolerate a mask
  some COPD patients.

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Oxygen Delivery

• Simple Face Mask Partial re-breather
• 6-10 liters/min
• 35-60 Oxygen delivery
• May be used on some medical patients or those
  with minor trauma most EMS systems recommend
  non-rebreather mask for patients who require
  oxygen.

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Oxygen Delivery

• Nonrebreather Mask
• Very good delivery device
• 10-15 liters/min
• 80-95 oxygen delivery
• Delivery device of choice for patients with
  hypoxia, shock, or the potential for shock use
  with caution in COPD patients.

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Oxygen Delivery

• Select desired cylinder. Check label Oxygen
  U.S.P.
• Place the cylinder in an upright position and
  stand to one side.
• Remove the plastic wrapper or cap protecting the
  cylinder outlet.
• Keep the plastic washer (some setups).
• Crack the main valve for one second.

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Oxygen Delivery

• Select the correct pressure regulator and
  flowmeter.
• Place the cylinder valve gasket on the regulator
  oxygen port.
• Make certain the pressure regulator is closed.
• Align pins, for DISS, thread by hand.
• Tighten T-screw for pin index.

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Oxygen Delivery

• Tighten with wrench for DISS
• Attach tubing and delivery device.
• Explain to patient the need for oxygen.
• Open main valve Adjust flowmeter.
• Place mask near your face and check for oxygen
  flow.
• Place oxygen delivery service
• Adjust flowmeter
• Always as a first choice, give FULL FLOW oxygen
  at 15 lpm with a non-rebreather mask.
• SECURE cylinder during transfer.

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Oxygen Delivery

• Discontinuing Oxygen
• Remove delivery device
• Close main valve
• Remove delivery tubing
• Bleed flowmeter
• Disassemble apparatus
• PROPERLY STORE

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Key Points

• An oxygen cylinder contains gas under pressure.
  If mishandled, the cylinder can cause serious
  damage.
• Different flow rates are used with different
  delivery devices.
• Never withhold supplemental oxygen, if you are
  trained to use it, from a person having
  difficulty breathing.

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Key Points

• When using a nasal cannula, deliver oxygen at 4
  to 6 lpm.
• When covering a victims mouth and nose with a
  mask, deliver oxygen at 10 or more lpm.
• When using a non-rebreather mask, make sure to
  inflate the bag before applying the mask to the
  victim. 10-15 lpm (Preferred).

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Key Points

• PRECAUTIONS
• DO NOT operate around flames or sparks.
• DO NOT stand the cylinder upright.
• DO NOT use grease, oil, or petroleum products to
  lubricate or use greasy hands to handle oxygen
  delivery devices.
• CHECK to see that oxygen is flowing through the
  device BEFORE putting it on the victim.

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Summary

• Breathing aids provide three major benefits
• Improved airway maintenance
• Increased oxygen delivery
• Infection control.
• NEVER delay resuscitation to locate special
  equipment.
• NEVER withhold oxygen from a patient who needs it.

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Summary

• The first responder must be able to provide basic
  life support airway, breathing, and circulation
  without any special equipment. However,
  breathing aids and oxygen administration improve
  the quality of artificial ventilation, and oxygen
  is effective therapy for a number of medical
  problems.

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Evaluation

• Which of the following is often difficult for a
  single rescuer using a BVM?
• Assembling the device for use with supplemental
  oxygen
• Squeezing a sufficient volume of air from the bag
  to effectively ventilate the victim
• Maintaining a tight enough seal and open airway.
• Seeing the area of the victims face under the
  mask clearly enough to detect vomiting if it
  occurs

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Evaluation

• The distinguishing color of an oxygen cylinder is
• Yellow
• Red
• Gray
• Green.

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Evaluation

• At what level of flow must you deliver oxygen
  with a BVM to achieve a 90 concentration?
• 1-4 lpm
• 4-5 lpm
• 6-8 lpm
• 8-10 lpm
• 10 lpm.

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Evaluation

• A pressure regulator should not be lubricated
  with a petroleum product because of the danger of
• Contamination of the oxygen
• Increased potential for an explosion.
• Loosening of the oxygen cylinder valve
• Inaccurate readings from the oxygen flowmeter

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Evaluation

• When you wish to manually sweep secretions from a
  victims mouth to clear the airway, you should
• Lift the neck and tilt the head
• Roll the victim onto the side and sweep the
  mouth.
• Use the triple airway maneuver
• Pull the jaw forward and move the tongue before
  sweeping the mouth

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Evaluation

• Because of the danger of disease transmission, an
  emergency responder should not initiate rescue
  breathing until a breathing device, such as a
  resuscitation mask, is available.
• True
• False.

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Evaluation

• A resuscitation mask should not be used on a
  victim with facial injuries because of the
  potential for causing further damage.
• True
• False.

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Evaluation (Match the left to the right)

• Resuscitation mask
• Non re-breathing mask
• Nasal cannula
• Bag valve mask
• Suction device

• Breathing victims only
• Breathing and non-breathing victims
• Non-breathing victims

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Where to Get More Information

• Ashland Community Technical College
• 4818 Roberts Drive
• Ashland, KY 41102
• 606-326-2478
• Robert Chaffins