Emergency Oxygen Administration 2012 EMS Safety Version A
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INTRODUCTION 2Emergency Oxygen Administration
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What We Will Learn Today Safe and effective administration of
emergency oxygen Definition of emergency oxygen When & how to
use it Safe assembly and storage Risks associated with oxygen
delivery Follow your local EMS authority or Medical Directors
guidelines Always use standard or universal precautions according
to your workplace and OSHA guidelines 3Emergency Oxygen
AdministrationIntroduction
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Key Concepts Every cell in the body needs oxygen (O 2 ) to live
In a medical emergency the body may inspire (inhale) or deliver
lower levels of oxygen Hypoxia (inadequate O 2 ) leads to organ and
brain damage Providing supplemental oxygen during an emergency may
delay damage to vital organs Emergency Oxygen
Administration4Introduction
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The Air We Breathe Not made of 100% oxygen Oxygen = 0 2 Made of
several different gasses 21% oxygen 78% nitrogen 1% other elements
The body only uses about 5% of inhaled oxygen in atmosphere 16%
oxygen in our exhaled air Enough to keep someone alive w/ rescue
breaths for a short time Emergency Oxygen
AdministrationIntroduction5 O 2 Molecules!
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Perfusion Oxygen perfusion is when cells receive oxygen-rich
blood Depending on condition or emergency, the victim may be able
to breathe but cant perfuse oxygen Emergency oxygen is a higher
concentration of oxygen than the air we breathe Emergency oxygen
can increase oxygen concentrations in the lungs, which may allow
more oxygen to be absorbed (perfused) into the bloodstream
Emergency Oxygen AdministrationIntroduction6
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COURSE OVERVIEW Emergency Oxygen Administration7
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Outline Respiration and Lung Function What is Emergency Oxygen
When to Use Emergency Oxygen Patient Assessment* Oxygen Equipment*
+ Delivery Devices* + Risks General Guidelines Safety Optional
Topics: Airway Adjuncts, Suctioning Written and Skills Testing
Emergency Oxygen AdministrationCourse Overview8 * Practice session
+ Required skill
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Certification Requirements Participate in entire course
Complete all practice sessions Pass written exam with minimum score
of 80% Pass skills exam Emergency Oxygen AdministrationCourse
Overview9
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RESPIRATION & LUNG FUNCTION Respiration: The exchange of
carbon dioxide for oxygen Emergency Oxygen Administration10
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Respiration & Ventilation Respiration Exchange of carbon
dioxide (CO 2 ), the waste product from breathing, with fresh air
from the atmosphere Ventilation Moving air in and out of the lungs
for respiration Alveoli Where the exchange of O 2 and CO 2 is
accomplished Small air sacs in the lower lobes of right and left
lungs Shaped like miniature broccoli stems Intertwined with
capillaries Exchange of O 2 and CO 2 occurs through fenestrations
(tiny holes) along the alveoli and capillary beds Emergency Oxygen
AdministrationRespiration & Lung Function11
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Blood Flow for Respiration Deoxygenated blood Pumped from right
ventricle of heart to lungs Down into alveoli O 2 /CO 2 exchanged
Newly-oxygenated blood Pumped back to left side of heart Out to the
rest of the body Emergency Oxygen AdministrationRespiration and
Lung Function12
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Lung Anatomy Emergency Oxygen AdministrationRespiration and
Lung Function13 Larynx Trachea Right Lung Left Lung Alveoli
Capillary beds Diaphragm
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WHAT IS EMERGENCY OXYGEN Emergency Oxygen Administration14
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Emergency Oxygen is a Compressed Gas Classified as a drug
Regulated by the FDA 100% pure oxygen stored in a cylinder
Categorized as either Medical Oxygen or Emergency Oxygen Rescuers
must be trained in use and storage of oxygen Emergency Oxygen
AdministrationWhat is Emergency Oxygen15
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Medical vs. Emergency Oxygen Concentrations are same for each
100% oxygen Differentiated by how each is used Oxygen delivery or
flow rate is calculated by the number of liters delivered per
minute (LPM) Medical oxygen Requires prescription for use Delivery
rate of less than 6 LPM OR Duration of less than 15 minutes
Emergency oxygen Training for rescuers required, prescription not
required At least 6 LPM for 15 minutes or longer Clearly labeled as
emergency oxygen Emergency Oxygen AdministrationWhat is Emergency
Oxygen16
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WHEN TO USE EMERGENCY OXYGEN How and when emergency oxygen is
used varies between Professional and Citizen rescuers. Always
follow state and local protocols regarding when and how to use
emergency oxygen. Emergency Oxygen Administration17
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Why Use Emergency Oxygen? Primary use: Correct mild - moderate
hypoxia (inadequate oxygen to organs and tissues) Reduce the work
of the heart Use to treat breathing difficulty based on Patients
condition Respiratory rates Emergency Oxygen AdministrationWhen to
Use Emergency Oxygen18 Professional rescuers and healthcare
providers may use emergency oxygen to treat signs and symptoms of
certain suspected medical conditions.
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When to Use Emergency Oxygen Citizen Rescuers Respiratory rates
that are too fast or too slow: Adult: 20/min. Child: 30/min.
Infant: 50/min. No breathing Cyanosis Diving decompression injury
Professional/Healthcare Same as citizen rescuers plus: Heart
attack/ACS Stroke Severe asthma Pulmonary embolism Clot affecting
blood supply to lungs Shock Drowning Pregnancy-related Exacerbated
COPD Lung disease Hypothermia Emergency Oxygen AdministrationWhen
to Use Emergency Oxygen19
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Never Delay Critical Care! The use of emergency oxygen should
not delay life-saving treatments Calling 9-1-1 Applying direct
pressure on a bleeding wound Starting chest compressions Only use
emergency oxygen after EMS (9-1-1) has been activated Additional
trained rescuers available to use emergency oxygen without
interrupting life-saving activities Emergency Oxygen
AdministrationWhen to Use Emergency Oxygen20
Patient Assessment Signs of Breathing Difficulty Labored
breathing Using accessory muscles in neck and back Speaking in
broken sentences Noisy breathing Coughing Wheezing/stridor Tripod
position Cyanosis To Calculate a Patients RPM Use stopwatch, second
hand or other timer Watch patients chest for 15 seconds Count
number of breaths Multiply number of breaths in 15 sec x 4 E.g. 5 x
4 = 20 RPM, a normal rate for adults Emergency Oxygen
AdministrationPatient Assessment22 Assess effort of breathing.
Calculate respirations per minute (RPM).
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Demo/Practice Session 1 Skill Demonstration: Patient Assessment
Skill Practice: Patient Assessment Instructions Use Practice Sheet
Demonstrate skill, answer questions Each student practices skill(s)
Use skill sheet to review areas for improvement Emergency Oxygen
AdministrationPatient Assessment23
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OXYGEN EQUIPMENT Emergency oxygen is delivered from a cylinder,
through a pressure regulator and oxygen tubing, and into a delivery
device such as a mask, cannula or bag mask Emergency Oxygen
Administration24
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Oxygen Cylinder Also known as a tank or bottle Typically green
or with green markings Labeled For emergency use only Made of
metal, aluminum or composite Highly pressurized Emergency Oxygen
AdministrationOxygen Equipment25
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Cylinders Vary in Size Each filled up to about 2015 psi
Cylinder sizes: D: 425 liters Jumbo D:640 liters E: 680 liters M:
3,000 liters G: 5,300 liters H: 6,900 liters D, Jumbo D & E
cylinders Small and portable Secure to gurney, stretcher or cot w/
patient Emergency Oxygen AdministrationOxygen Equipment26
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Pressure Regulator Connects cylinder valve to O 2 tubing
Controls rate of flow (measured in LPM) Two types Dual flow: high
or low Full Control: 2 to 25 LPM Gauge displays amount of pressure
per sq. inch 2000 psi = full 1000 psi = full 500 psi = time to
refill Emergency Oxygen AdministrationOxygen Equipment27 Oxygen
Wrench: Opens cylinder valve to begin O 2 flow into regulator Full
Control Pressure Regulator
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O-Ring & Oxygen Tubing O-ring Gasket creates tight seal
between cylinder valve and regulator Over time may require
replacement Without it air escapes between cylinder and pressure
regulator Replacement o-ring usually with newly-filled cylinder
Oxygen Tubing Connects regulator to O 2 delivery device Comes in
different lengths Is pre-connected to delivery devices Emergency
Oxygen AdministrationOxygen Equipment28 O-Ring
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Delivery Device Used by the patient to breathe in emergency
oxygen Usually a mask that fits over the mouth and nose Connected
to the cylinder w/ oxygen tubing Emergency Oxygen
AdministrationOxygen Equipment29
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Demand Valve Used by specially-trained professional rescuers
Triggered by patient inhaling or by push of button/lever Delivers
100% oxygen at 40 LPM Due to force adults only! Green tube attaches
to special outlet on regulator Emergency Oxygen
AdministrationOxygen Equipment30 Demand Button
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Oxygen Humidifier Not typically used in emergency settings
Supplemental O 2 can dry out mucous membranes of the nose Dryness
causes irritation and possible nosebleed Humidifier passes O 2
through sterile water O 2 picks up tiny water molecules, reduces
dryness & irritation Emergency Oxygen AdministrationOxygen
Equipment31
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Pulse Oximeter Small, portable electronic device Estimates and
monitors blood-oxygen saturation level (how much O 2 in blood) Uses
an infrared probe Normal level between 95% and 100% Additional
training required for use Emergency Oxygen AdministrationOxygen
Equipment32
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Using a Pulse Oximeter How To Use: Turn on, connect probe to
finger, earlobe or foot/toe Register oxygen saturation level (SpO 2
) and pulse rate Verify pulse rate on monitor w/ patient's actual
pulse Monitor and record SpO 2 Follow protocols to titrate based on
target O 2 levels Typically 94% to 99% Less effective when: No
breathing/heart beat Poor perfusion: shock, low blood pressure
Fingernail polish present Excessive patient motion Hypothermia
Carbon monoxide poisoning/some smokers Hx. of sickle cell disease
or anemia Swelling of monitored extremity Emergency Oxygen
AdministrationOxygen Equipment33
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Connecting the Pressure Regulator Inspect valve, ensure dry
& clean Slowly open & close valve to expel debris Inspect
regulator and o-ring; replace if worn Line up pins on regulator w/
holes on cylinder valve Twist thumbscrew hand tight Turn gauge away
from you, open valve Read gauge to determine content Listen for
airtight seal Emergency Oxygen AdministrationOxygen
Equipment34
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Demo/Practice Session 2 Skill Demonstration: Connect Pressure
Regulator Skill Practice: Connect Pressure Regulator Instructions
Use Practice Sheet Demonstrate skill, answer questions Each student
practices skill(s) Use skill sheet to review areas for improvement
Emergency Oxygen AdministrationOxygen Equipment35
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DELIVERY DEVICES The delivery device is connected to oxygen
tubing, then attached to the nipple of the pressure regulator.
Emergency Oxygen Administration36
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Key Concepts There are four basic types Non-rebreather mask
Nasal cannula Bag mask CPR face mask w/ oxygen inlet The
non-rebreather and nasal cannula are for victims who are breathing
on their own Different sizes of delivery devices are available for
adult, child and infant patients Emergency Oxygen
AdministrationDelivery Devices37
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Non-Rebreather Mask High-flow device Consists of mask, O 2
reservoir and tubing Delivers oxygen concentrations between
90%-100% with each breath Use 15 LPM Emergency Oxygen
AdministrationDelivery Devices38
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Using a Non-Rebreather Mask Connect tubing to regulator Adjust
flow rate to 15 LPM Listen for flow of O 2 Briefly cover one-way
valve inside mask to speed up filling reservoir Place over the
patient's mouth and nose Emergency Oxygen AdministrationDelivery
Devices39
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Tolerating a Non-Rebreather Mask The mask will completely cover
the mouth & nose, which can make it intolerable for some
Patient may complain that flow of O 2 is restricted, even though
they are getting more than 90% O 2 Ensure flow rate is at least 15
LPM, oxygen is flowing and the reservoir is inflated Rescuers may
have to coach a patient Help get used to mask Reassure they are
getting more oxygen than normal Emergency Oxygen
AdministrationDelivery Devices40
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Nasal Cannula A low-flow device Provides between 2 - 6 LPM Max
concentration delivered: 44% O 2 Consists of loop of oxygen tubing,
two prongs for the nostrils and an adjusting band Emergency Oxygen
AdministrationDelivery Devices41
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Using a Nasal Cannula Emergency Oxygen AdministrationDelivery
Devices42 Connect tubing to regulator Adjust flow rate: 6 LPM
Listen for flow of O 2 Open cannula loop Holding loop w/ thumb and
forefinger, insert prongs into nose Wrap each side around patients
ears Slide adjusting band up Instruct the patient to breathe in
through nose
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Bag Mask Emergency Oxygen AdministrationDelivery Devices43 Also
known as Bag Valve Mask or BVM Used for rescue breathing/CPR
Delivers nearly 100% oxygen May reduce exposure to pathogens
Requires additional training to be used effectively
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Using a Bag Mask May be used with or without oxygen Science
does not support or refute the use of oxygen during resuscitation
Risks related to over-exposure to oxygen are low; it is reasonable
to use oxygen during resuscitation Never delay resuscitation
efforts in order to use emergency oxygen The use of emergency
oxygen does not change how rescue breaths are delivered with a bag
mask Emergency Oxygen AdministrationDelivery Devices44
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Emergency Oxygen AdministrationDelivery Devices45 Bag masks use
positive pressure to push air into the lungs w/ each squeeze of the
bag A bag mask consists of Rigid face mask Self-inflating bag
Oxygen reservoir Oxygen tubing Components of a Bag Mask
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Using a Bag Mask w/ O 2 Follow guidelines for CPR/AED &
activating EMS Assemble mask, bag and tubing Connect tubing to
oxygen source O 2 flow of 15 LPM Use bag mask to give rescue
breaths Reservoir does not need to inflate Emergency Oxygen
AdministrationDelivery Devices46 Ensure a good seal between face
and mask
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CPR Mask with 0 2 Inlet Emergency Oxygen AdministrationDelivery
Devices47 Used for rescue breathing Increases oxygen delivery w/
mouth-to- mask rescue breaths Can deliver up to 55% oxygen
Available in adult, child, infant sizes Seal tightly to the face to
give breaths Oxygen Inlet
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Using a CPR Face Mask w/ Oxygen Follow guidelines for CPR/AED
& activating EMS Assemble mask Insert tubing into oxygen inlet
on mask Connect tubing to oxygen source O 2 flow of 15 LPM Press
mask firmly to the face and open airway Breathe into mask and watch
for chest rise Emergency Oxygen AdministrationDelivery
Devices48
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Bag Mask & CPR Face Mask Can be used for resuscitation, or
to provide emergency oxygen to a victim who is conscious or
semi-conscious but breathing abnormally Bag Mask Maintain flow rate
of 15 LPM Have victim hold to his/her face if able Assist abnormal
rates as needed: Less than 10 RPM: Squeeze bag between each breath
Greater than 30 RPM: Squeeze bag every second breath CPR Face Mask
Use 6-15 LPM Have patient hold mask to his/her face Emergency
Oxygen AdministrationDelivery Devices49
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Selecting a Delivery Device Regulator Type Impacts Delivery
Device Full control regulator (2-25 LPM) Any type mask acceptable
Dial in proper LPM according to device Dual flow: high or low
Low-flow setting Nasal cannula CPR face mask (for patient is who is
breathing) High-flow setting Non-rebreather mask Bag mask CPR face
mask (for breathing or non-breathing patient) Emergency Oxygen
AdministrationDelivery Devices50
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Blow By Oxygen Delivery For infants and small children who cant
tolerate a mask or cannula Use an oxygen mask and a high flow rate
(at least 15 LPM) Keep mask about 2 inches from patient's face Wave
mask slowly from side-to-side Allows oxygen to pass over patient's
mouth and nose to be inhaled Emergency Oxygen
AdministrationDelivery Devices51
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Demo/Practice Session 3 Skill Demonstration: Delivery Devices
Skill Practice: Delivery Devices Instructions Use Practice Sheet
Demonstrate skill, answer questions Each student practices skill(s)
Use skill sheet to review areas for improvement Emergency Oxygen
AdministrationDelivery Devices52
Risks of Oxygen Delivery Potential risks related to oxygen
delivery Oxygen Toxicity Retinopathy of Prematurity Denitrogenation
COPD and the Hypoxic Drive Emergency Oxygen AdministrationOxygen
Risks54
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Oxygen Toxicity Occurs when there is too much oxygen in the
blood Caused by prolonged exposure to high concentrations of oxygen
Usually after 24 hours or more Emergency oxygen is usually not
administered long enough to cause oxygen toxicity, and is generally
not a concern in the field Signs/symptoms: visual changes, ringing
in ears, twitching, irritability, dizziness, seizure Emergency
Oxygen AdministrationOxygen Risks55
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Retinopathy of Prematurity Retinopathy of prematurity only
occurs in premature infants The retinas are immature before 34
weeks gestation, and can be damaged by high concentrations of
oxygen It is not a problem associated with the normal use of
emergency oxygen Emergency Oxygen AdministrationOxygen Risks56
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Denitrogenation Also known as Absorption Atelectasis Occurs
when naturally-occurring nitrogen in the lungs is replaced with
oxygen from over-saturation Oxygen shares alveolar space with
nitrogen If the nitrogen is washed out by too much O 2, the alveoli
collapse Can severely impair lung function (process known as
atelectasis) Not usually associated with emergency oxygen delivery
because exposure to high concentrations of oxygen is limited to a
relatively short period Emergency Oxygen AdministrationOxygen
Risks57
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COPD and Hypoxic Drive Hypoxic drive is condition associated w/
COPD Normally, body stimulated to breathe when too much carbon
dioxide is detected COPD patients stimulated to breathe by lower O
2 levels and to NOT breathe with higher O 2 levels Concern that
emergency oxygen can eliminate the hypoxic drive of a COPD patient,
causing person to stop breathing General rule: Always give
emergency O 2 if indicated (even if history of COPD) Difficulty
breathing may be related to a condition other than COPD Hypoxic
drive is rare; do not withhold emergency O 2 Emergency Oxygen
AdministrationOxygen Risks58
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GENERAL GUIDELINES FOR EMERGENCY OXYGEN DELIVERY Emergency
Oxygen Administration59
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General Guidelines Guidelines for the delivery of emergency O 2
include the following: Monitor delivery Understand the use of
oxygen in resuscitation Train emergency responders Follow federal,
state and local regulations Emergency Oxygen
AdministrationGuidelines for Oxygen Delivery60
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Monitor Oxygen Delivery Emergency oxygen delivery should be
based on target saturation levels, not fixed flow rates Using
oxygen to treat breathlessness rather than low oxygen saturation
has not been shown to help feeling of breathlessness Pulse oximetry
is recommended to monitor blood-oxygen levels When a pulse oximeter
is available, titrate oxygen delivery to the lowest effective
level. Emergency Oxygen AdministrationGuidelines for Oxygen
Delivery61
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Emergency Oxygen & Resuscitation Science is inconclusive
about the use of emergency oxygen during resuscitation Studies show
emergency oxygen during resuscitation: Increases amount of oxygen
in the blood Has little risk of complications Ensure resuscitation
efforts are NEVER DELAYED in order to use emergency oxygen After a
return of spontaneous circulation (ROSC) Titrate delivery to the
lowest level possible Maintain an SpO 2 of 94%-99% Emergency Oxygen
AdministrationGuidelines for Oxygen Delivery62
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Training for Emergency O 2 Use The Organizations medical
authority should review and approve use and training methods before
equipping staff Train at least one staff member in use of emergency
oxygen at all times during business hours Training should be
certification level from a nationally-recognized organization
Training should incorporate any local guidelines that may differ
from this training Emergency Oxygen AdministrationGuidelines for
Oxygen Delivery63
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OXYGEN SAFETY Emergency Oxygen Administration64
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Key Concepts Oxygen is very reactive and can create a dangerous
situation by making items more flammable When the oxygen level is
increased, it is easier to start a fire and very difficult to put
it out Take precautions when Using emergency oxygen w/
defibrillator Storing and handling cylinders Emergency Oxygen
AdministrationOxygen Safety65
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Using Oxygen w/ a Defibrillator 100% oxygen is combustible Good
chest-to-pad contact Eliminates oxygen pockets between pad and skin
Reduces risk for AED use w/ oxygen Move mask at least 3 feet from
victim before shocking Loudly state Oxygen clear Only shock when
rescuers & oxygen are clear Emergency Oxygen
AdministrationOxygen Safety66
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Cylinder Storage Store cylinders Upright Secured to prevent
falling Avoid storing different types of compressed gasses in the
same area Store in a well-ventilated area Do not subject cylinders
to temperatures greater than 125 o F, prolonged exposure to direct
sunlight, or exposure to other heat sources (e.g. radiator, space
heater) Emergency Oxygen AdministrationOxygen Safety67
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Cylinder Maintenance Regularly inspect equipment and document
inspections according to national and local guidelines and
manufacturer specifications Ensure labels and signs are in
compliance w/ federal OSHA, state and local regulations Do not use
a cylinder that appears damaged Keep oxygen equipment clean. Dirt
and debris can be a fire hazard Use a pressure gauge to check
contents; do not rely solely on a tagging system (Full, In-Use,
Empty) Emergency Oxygen AdministrationOxygen Safety68
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Cylinder Handling Do not slide, drag or roll cylinders Do not
use oil or grease on oxygen equipment When on scene, lay the oxygen
cylinder on the floor so it does not get knocked over accidentally
If transporting the cylinder with the patient, secure it to the
cot, stretcher or gurney so that it does not slip or get knocked
off Emergency Oxygen AdministrationOxygen Safety69
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Storage Emergency Oxygen AdministrationOxygen Safety70 What is
wrong with this picture?
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Oxygen is Combustible 100% oxygen is highly reactive, and can
cause other materials to catch on fire Keep away from heat sources
and flammable items Avoid alcohol, aerosol sprays, solvents,
perfumes and petroleum products Never combine oxygen with an
ignition source (e.g. cigarette) Emergency Oxygen
AdministrationOxygen Safety71
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OPTIONAL TOPICS Suction Devices and Airway Adjuncts Emergency
Oxygen Administration72
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Suctioning & Airway Adjuncts Objectives Identify equipment
associated w/ the use of emergency oxygen and airway management Key
Concepts Its important to be familiar w/ the equipment that may be
used by all levels of rescuers Oxygen delivery may also be
associated with Advanced airway adjuncts Suction devices Emergency
Oxygen AdministrationSuction Devices & Airway Adjuncts73
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Suction Devices Remove blood, secretions or vomit from the
airway Manual, battery operated (portable) and bedside Tip
(catheter) may be rigid or flexible Emergency Oxygen
AdministrationSuction Devices & Airway Adjuncts74 Portable
Suction Device
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Using a Suction Device 1. Measure distance from corner of mouth
to ear lobe (max. distance for suction tip to be inserted) 2.
Remove CPR barrier or bag while suctioning Emergency Oxygen
AdministrationSuction Devices & Airway Adjuncts75 Rigid Suction
Tip Flexible Suction Tip
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Airway Adjuncts Used for patient in severe distress
Unresponsive or semiconscious Rescue breathing Cardiac arrest
Airway adjuncts establish and maintain an open airway Simple
airways can be used w/ no change to CPR sequence Oral airway Nasal
airway Advanced airways require change in delivery of compressions
& ventilations Emergency Oxygen AdministrationSuction Devices
& Airway Adjuncts76
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Oral Airway Most commonly used Keeps tongue off back of airway
For unresponsive victim w/o gag reflex Choose correct size Measure
from front teeth to angle of jaw (or earlobe) Too large can block
airway Place along roof of mouth and rotate into position The end
rests on the lips Pro-Rescuer CPR/AEDSuction Devices & Airway
Adjuncts77
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Nasal Airway For semiconscious victim w/ gag reflex Tolerated
more easily than oral airway Does not control airway as well as
oral airway Measure distance from base of nose to base of ear Do
not use if: Severe facial trauma Suspected basilar skull fracture
Pro-Rescuer CPR/AEDSuction Devices & Airway Adjuncts78
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Advanced Airways Inserted by ALS -trained personnel Blocks the
esophagus Keeps vomit out of airway and airway open Do not perform
cycles of compressions and ventilations 100 compressions per minute
w/o pausing 1 breath every 6-8 seconds Independent of each other
Pro-Rescuer CPR/AEDSuction Devices & Airway Adjuncts79
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Conclusion Never delay critical care to provide emergency
oxygen Follow federal, state and local protocols Only provide
oxygen when indicated by patient assessment At the earliest
opportunity, titrate oxygen LPM and delivery device to the lowest
level possible to maintain SpO 2 94-99% Emergency Oxygen
AdministrationConclusion80