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Teaching Your Students New Oxygen Administration Techniques

May 24, 2012 Leave a comment
Dan LImmer

Photo Credit: EMSWebSummit

The way oxygen is administered has changed quite dramatically in the past few years. The old oxygen delivery theory of “everyone gets high concentration oxygen by non-rebreather” is clearly not the case anymore. The 2010 American Heart Association guidelines were a major reason for this change.

There are three major concepts explaining why practices have changed. Use these as a guide when making decisions about oxygen administration:

  • Oxygen is a drug. Like any drug, a patient may be given too little or too much. All other medications are given based on need and therapeutic benefit. We must keep this in mind as a fundamental concept in oxygen delivery.
  • Oxygen can cause harm. Current research indicates that oxygen can actually cause harm in reperfusion situations at the cellular level. In cases of heart attack and stroke, parts of the heart or brain are deprived of oxygen. As a result, toxic byproducts of this anaerobic metabolism build up in the cells. When perfusion is restored to these areas, oxygen reacts with free radicals and other substances causing significant damage at the cellular level and may even send these toxins to other parts of the body as well.  Although some cells will die as a result of the initial stroke or myocardial infarction, it is the surrounding cells that still have a chance to recover that are at greatest risk during reperfusion.
  • Oxygen should be administered based on your overall evaluation of the patient’s presentation and possible underlying conditions. Patients who have oxygen saturations below 94% and those who show signs of hypoxia or criticality (e.g. pale skin, altered mental status, cyanosis, difficulty breathing) should receive oxygen based on severity and in an effort to improve oxygen saturation. Don’t withhold oxygen from a patient in distress regardless of oxygen saturation readings. In a significant number of cases a nasal cannula will be enough to raise saturation and benefit the patient with less potential for causing harm.

Always remember to ventilate rather than oxygenate patients in respiratory failure or arrest. Apply oxygen to the BVM or pocket face mask while ventilating patients.

The 2010 American Heart Association guidelines deal with patients with acute coronary syndromes and stroke. Many however believe that the oxygen administration guidelines also have some application to trauma patients. If you had a patient with an isolated tibia and fibula fracture with no signs of shock or other injury and an adequate oxygen saturation, oxygen might not be necessary at all, or if administered, only with a nasal cannula. Similar to medical patients, trauma patients showing signs of hypoperfusion or hypoxia should still receive high concentration oxygen.

We recognize that these new guidelines will require solid patient assessment and clinical judgment when making decisions regarding oxygen—both in the field and on your examinations for certification. One thing appears clear however; the days of automatically administering high concentration oxygen by non-rebreather mask are over.

This blog post is a result of collaboration between Brady authors Dan Limmer, Mike O’Keefe, Ed Dickinson, M.D., and Joe Mistovich.

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