1. 9
Oxygen Therapy

2. Define the following terms:
Objectives
Define the following terms:
blow-by method
humidifier
hydrostatic test
liter flow
nasal cannula
nonrebreather mask
O ring
(continued)

3. Define the following terms:
Objectives
Define the following terms:
oxygen concentration
oxygen supply tubing
pin index system
pressure gauge
pressure regulator
reservoir bag
supplemental oxygen
(continued)

4. Explain the benefits of supplemental oxygen.
Objectives
Explain the benefits of supplemental oxygen.
Explain the indications of supplemental oxygen.
Explain the potential hazards of working with high-pressure cylinders.
Explain the safe practices when working with high-pressure cylinders.
Differentiate between the common sizes of oxygen cylinders used in EMS.
(continued)

5. Describe the purpose and functions of an oxygen regulator.
Objectives
Describe the purpose and functions of an oxygen regulator.
Explain the indications for the use of a nasal cannula.
Explain the indications for the use of a nonrebreather mask.
Demonstrate the proper use of a nonrebreather mask.
Demonstrate the proper use of a nasal cannula.
(continued)

6. Objectives
Demonstrate the ability to add supplemental oxygen to a pocket mask and/or bag-mask device.
Demonstrate the proper technique for attaching a regulator to a cylinder.
Demonstrate the ability to identify and troubleshoot a leaky oxygen cylinder/regulator.
Recognize the value that supplemental oxygen might offer for most ill and injured patients.

7. Topics Importance of Oxygen Hazards of Oxygen Oxygen Therapy Equipment
Administering Oxygen

8. IMPORTANCE OF OXYGEN

9. Importance of Oxygen Oxygen is a drug.
The air we breathe contains 21 percent oxygen.
Supplemental oxygen is 100 percent oxygen.
Oxygen concentration: amount of oxygen being delivered to patient.
Critical Thinking: The air we exhale contains about 16 percent oxygen. Compare and contrast mouth-to-mouth rescue breaths to providing supplemental oxygen.

10. Importance of Oxygen Patient may need oxygen for:
Respiratory or cardiac compromise
Cardiac arrest
Shock
Major blood loss
Injury to lungs or chest
Airway obstruction
Stroke
Teaching Tip: Use web resources or a lung sound simulator to demonstrate lung sounds (normal and abnormal). At a minimum, this should include a patient in respiratory distress (e.g., CHF or COPD).

11. Importance of Oxygen Common Indicators Abnormal signs and symptoms
Significant mechanism of injury
Increased level of distress
Talking Point: Identifying what is normal is an important first step to learning what is abnormal.
Class Activity: Using stethoscopes, direct students to work in pairs to listen to each other's lung sounds. Ask that they continue their practice of listening to normal lung sounds at home with family members.

12. Think About It What physiological needs are met by adequate breathing?
What are some causes of inadequate breathing?
What are the signs of inadequate breathing?

13. HAZARDS OF OXYGEN

14. Hazards of Oxygen
Oxygen may be under 2,000 pounds per square inch (psi) of pressure (full tank).
If tank is punctured or valve breaks off, supply tank and valve can become deadly projectiles.
Talking Point: A small car (e.g., VW Beetle) weighs approximately 2,000 lbs. Imagine this weight on each inch of the tank's inner surface!

15. Hazards of Oxygen
Oxygen itself is nonflammable, but it greatly increases rate and intensity of combustion.
Oxygen and oil do not mix.
Teaching Tip: Check web resources for oxygen tank related explosions and fires; share video and/or articles with students.

16. Think About It Do not underestimate the dangers of oxygen!
What safety precautions should the EMR take when working with oxygen cylinders?
Which placards are used by the U.S. Dept. of Transportation for pressurized oxygen?
Teaching Tip: Direct students to consult the US DOT Emergency Response Guidebook (ERG) for the placard symbols.

17. OXYGEN THERAPY EQUIPMENT

18. Oxygen Therapy Equipment
Oxygen-delivery System:
Oxygen source
Regulator
Delivery device
Oxygen Cylinders
Aluminum cylinders filled with pressurized oxygen.
(continued)

19. An oxygen-delivery system.

20. Oxygen Therapy Equipment
Oxygen Cylinders
Various sizes, identified by letters.
D cylinder (425 liters oxygen)
Jumbo D cylinder (640 liters oxygen)
E cylinder (680 liters oxygen)
Talking Point: Explain to students that the large cylinder housed in most ambulances is an M cylinder. EMTs may refer to it as their “in-house” oxygen. Once placed in the ambulance, the patient will typically be transferred to this larger source of oxygen.
(continued)

21. Various-size portable oxygen cylinders.
Talking Point: Explain to students that E cylinders may sometimes be found in patient's homes. Patients requiring long-term supplemental oxygen will sometimes have an E cylinder secured in a transport device with wheels so they can move from room to room.
Various-size portable oxygen cylinders.

22. Oxygen Therapy Equipment
Oxygen Cylinders
Pressure gauge determines pressure remaining in tank.
Never allow to go completely empty.
Never allow pressure in oxygen cylinder to fall below 200 psi.
Critical Thinking: Why should the tank not be allowed to fall below 200 psi?

23. Oxygen Therapy Equipment
Oxygen System Safety
Never allow smoking.
Never use around open flames or sparks.
Never use grease or oil.
Never put tape on cylinder.
Discussion Question: What should you do if you arrive on scene to find a patient in need of oxygen while a family member is smoking in the same room?
(continued)

24. Oxygen Therapy Equipment
Oxygen System Safety
Never store near high heat or in a closed vehicle parked in the sun.
Keep portable cylinders lying flat.
Use pressure gauges and regulators.
Ensure O ring is in good condition.
Talking Point: Some O rings are loose and separate from the tank. Use care not to loose the O ring.
(continued)

25. Oxygen Therapy Equipment
Oxygen System Safety
Valves/connections hand-tight only.
Open and close all valves slowly.
Store in cool, ventilated room.
Have hydrostatically tested.
Critical Thinking: Why is it important to hand-tighten valves and connections?

26. Oxygen Therapy Equipment
Oxygen Regulators
Pressure in full oxygen cylinder: 2,000 psi.
Regulators have three functions:
Reduce tank pressure
Display tank pressure
Control delivery of oxygen
Class Demonstration: Demonstrate a regulator leak (e.g., when O ring is not “seated” properly) and show how to resolve the problem.
(continued)

27. Pressure regulators, one on and one off the tank.
Talking Point: The regulator should be checked for adequate pressure before every shift and after every call.
Pressure regulators, one on and one off the tank.

28. Oxygen Therapy Equipment
Oxygen Regulators
Connecting the Regulator
Pin index system: safety system used to ensure proper regulator is used for specific gas.
Largest pin is oxygen port.
O ring ensures airtight seal between regulator and tank valve.
Class Activity: Have several D size oxygen tanks and regulators available. Demonstrate and then direct students to properly connect the regulator.
(continued)

29. The PIN safety system.

30. Oxygen Therapy Equipment
Oxygen Regulators
Humidifiers
Unbreakable container of sterile water.
Oxygen becomes more comfortable for patient to breathe.
Many EMS systems no longer use humidifiers due to infection risk.
Talking Point: Humidified oxygen may be seen in patient's homes when they are on continuous oxygen therapy. It is also used for long EMS transports. To minimize infection risk; only one-time use disposable sterile water containers should be used.

31. Oxygen Therapy Equipment
Oxygen-Delivery Devices
Nasal cannula
Used to deliver low concentrations of supplemental oxygen to breathing patient.
Nonrebreather mask
Used to deliver high concentrations of supplemental oxygen.
Discussion Question: In what cases would you choose to use a nasal cannula for your patient? A nonrebreather?
(continued)

32. Oxygen-Delivery Devices
Discussion Question: In what cases would you choose to use a nasal cannula for your patient? A nonrebreather?
Oxygen-Delivery Devices

33. Example of a nasal cannula.

34. A nasal cannula properly placed on the face of the patient.

35. Oxygen Therapy Equipment
Oxygen-Delivery Devices
Nonrebreather mask
Face mask, one-way valve, reservoir bag.
Inflate bag before placing on patient's face.
Always ensure adequate oxygen flow (12–15 lpm).
Class Activity: If possible to obtain a sufficient supply of nonrebreather masks; distribute one to each student and have them place one on their face without supplemental oxygen. This should help emphasize the importance of always ensuring adequate oxygen supply before placing the mask on a patient's face.
(continued)

36. Example of a nonrebreather mask.

37. A nonrebreather properly placed on the face of a patient.

38. Oxygen Therapy Equipment
Oxygen-Delivery Devices
Venturi mask
Adjustable “jets” that allow user to more accurately determine specific oxygen concentration.
Talking Point: Venturi masks or “simple” face masks may not be commonly used in the EMS setting.
(continued)

39. Oxygen Therapy Equipment
Oxygen-Delivery Devices
Blow-by Delivery
Used for patient who will not tolerate traditional mask or cannula placed on face.
Especially good for small children.
Teaching Tip: Demonstrate placing the end of an oxygen tube into the bottom of a paper cup and allow students to examine. This technique is useful for small children since a cup is a familiar item and less scary to them.

40. Think About It
What is the length of time an oxygen cylinder can be used?
How often should the oxygen regulator be checked for adequate pressure?
Answer #1: It depends upon the amount of oxygen in the cylinder and the flow rate of the oxygen.
Answer #2: The regulator should be checked for adequate pressure before every shift and after every call.

41. ADMINISTERING OXYGEN

42. Administering Oxygen
Step-by-step process of preparing oxygen-delivery system and administering oxygen.
Three devices:
Pocket mask with oxygen inlet
Bag-mask device
Demand-valve device
Discussion Question: What are the advantages and disadvantages of a pocket mask?

43. Remove the plastic wrapper or cap protecting the cylinder outlet.

44. Keep the plastic washer that is used in some setups.

45. “Crack” the main valve for one second.

46. Place cylinder valve gasket on regulator oxygen port.

47. Tighten T-screw hand-tight
Tighten T-screw hand-tight. Do not overtighten because this can crush or crack the washer, thus causing a leak.

48. Attach tubing and delivery device.

49. Explain the need for oxygen therapy.

50. Open the main valve.

51. Attach the delivery device and adjust flow meter.

52. Be sure to fill the reservoir bag prior to placing it on the patient by turning on the flow and placing your finger over the valve in the mask.

53. Position the oxygen-delivery device on the patient.

54. Secure the cylinder during transfer.

55. Administering Oxygen Pocket Mask with Oxygen Inlet Bag-Mask Device
Delivers higher concentrations of oxygen than pocket mask alone.
Bag-Mask Device
Capable of accepting supplemental oxygen.
Works best when used by two rescuers.
Talking Point: The proper use of the Bag-Mask device is a difficult skill to master, especially by one rescuer. The EMR should practice frequently.

56. One mask without and one with an oxygen inlet.
Class Activity: Using airway manikins, direct students to work in pairs to practice pocket mask use with supplemental oxygen.
One mask without and one with an oxygen inlet.

57. Rescuer delivering her own breath through the mask's chimney plus oxygen through the inlet. (Photo courtesy of Laerdal Medical Corporation)

58. Class Activity: Using airway manikins, direct students to work in pairs to practice bag-mask use with supplemental oxygen. Next have students work in groups of three to practice and compare the improvement in performance with the added rescuer.
Bag-mask device connected to an oxygen supply. (Photo courtesy of Laerdal Medical Corporation)

59. Administering Oxygen Demand-Valve Device
Delivers oxygen through regulator that can deliver 100 percent oxygen “on demand” when patient inhales.
Monitor patient carefully when providing assisted ventilations.
Talking Point: Many departments have abandoned the use of demand-valve devices due to the risk of patient injury.

60. Administering Oxygen General Guidelines for Oxygen Therapy
Explain you would like to provide oxygen; it will help the patient feel better.
Show device; explain how it works; and how it will fit on face.
Gently place device on face and confirm patient is comfortable; adjust as necessary.
(continued)

61. Administering Oxygen General Guidelines for Oxygen Therapy
Remind patient to breathe as normally as possible.
If patient is anxious and reluctant to accept device, provide extra reassurance.
Monitor patient closely.
Class Activity: Direct students to work in pairs to role-play oxygen administration using a nasal cannula and nonrebreather.

62. Think About It
What are the advantages and disadvantages of each type of oxygen delivery device?
Why is it important, if at all possible, to explain to a patient what you are doing during oxygen administration?
When is it appropriate NOT to administer oxygen?

63. SUMMARY

64. Summary
Most ill or injured patients will benefit from supplemental oxygen.
Oxygen is stored and transported in portable containers called cylinders.
Important to keep high-pressured cylinders lying flat on ground to minimize damage.

65. Summary
Cylinders should be stored in cool environment and away from sources of flame or heat.
Commonly used cylinders in EMS are the D, Jumbo D, and E cylinders.
Pressure regulator used to reduce pressure of oxygen coming out of cylinder.

66. Summary Two devices used to provide supplemental oxygen:
Nasal cannula can deliver oxygen concentrations up to 44 percent.
Nonrebreather mask capable of delivering oxygen concentrations up to approximately 90 percent.

67. Summary
Amount of supplemental oxygen provided to patient determined by:
Mechanism of injury
Signs and symptoms
Level of distress

68. Summary
When a patient is not breathing adequately, provide positive pressure ventilations.
Can be performed by using:
Pocket mask.
Bag-mask.
Demand-valve device.

69. REVIEW QUESTIONS

70. What are the benefits of supplemental oxygen?
Review Questions
What are the benefits of supplemental oxygen?
What are the potential hazards of working with high-pressure cylinders?
When working with high-pressure cylinders, what safe practices should you employ?
What size oxygen cylinder is commonly carried in an O2 bag by EMS?
(continued)

71. What is the purpose and function of an oxygen regulator?
Review Questions
What is the purpose and function of an oxygen regulator?
What are the indications for the use of the following:
Nasal cannula?
Nonrebreather?
Pocket mask?
Bag-mask?
Answer #4: The D size cylinder is commonly carried by EMS in a portable oxygen bag.

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