Emergency Oxygen
Administration
© 2012 EMS Safety
Version A
INTRODUCTION
Emergency Oxygen Administration
2
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
Director’s guidelines
• Always use standard or universal precautions
according to your workplace and OSHA guidelines
Emergency Oxygen Administration
Introduction
3
Key Concepts
• Every cell in the body needs oxygen (O2) to live
• In a medical emergency the body may inspire
(inhale) or deliver lower levels of oxygen
• Hypoxia (inadequate O2) leads to organ and
brain damage
• Providing supplemental oxygen during an
emergency may delay damage to vital organs
Emergency Oxygen Administration
Introduction
4
The Air We Breathe
• Not made of 100% oxygen
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Oxygen = 02
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
O2 Molecules!
Emergency Oxygen Administration
Introduction
5
Perfusion
• Oxygen perfusion is when cells receive
oxygen-rich blood
• Depending on condition or emergency, the victim
may be able to breathe but can’t 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 Administration
Introduction
6
COURSE OVERVIEW
Emergency Oxygen Administration
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Outline
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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 Administration
Course Overview
* 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 Administration
Course Overview
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Respiration: The exchange of carbon dioxide for oxygen
RESPIRATION & LUNG
FUNCTION
Emergency Oxygen Administration
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Respiration & Ventilation
• Respiration
– Exchange of carbon dioxide (CO2), the waste product
from breathing, with fresh air from the atmosphere
• Ventilation
– Moving air in and out of the lungs for respiration
• Alveoli
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Where the exchange of O2 and CO2 is accomplished
Small air sacs in the lower lobes of right and left lungs
Shaped like miniature broccoli stems
Intertwined with capillaries
Exchange of O2 and CO2 occurs through fenestrations
(tiny holes) along the alveoli and capillary beds
Emergency Oxygen Administration
Respiration & Lung Function
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Blood Flow for Respiration
• Deoxygenated blood
– Pumped from right ventricle of heart to lungs
– Down into alveoli
– O2/CO2 exchanged
• Newly-oxygenated blood
– Pumped back to left side of heart
– Out to the rest of the body
Emergency Oxygen Administration
Respiration and Lung Function
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Lung Anatomy
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Larynx
Trachea
Right Lung
Left Lung
Alveoli
Capillary
beds
• Diaphragm
Emergency Oxygen Administration
Respiration and Lung Function
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WHAT IS EMERGENCY
OXYGEN
Emergency Oxygen Administration
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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 Administration
What is Emergency Oxygen
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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 Administration
What is Emergency Oxygen
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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.
WHEN TO USE EMERGENCY
OXYGEN
Emergency Oxygen Administration
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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
– Patient’s condition
– Respiratory rates
• Professional rescuers and healthcare providers
may use emergency oxygen to treat signs and
symptoms of certain suspected medical conditions.
Emergency Oxygen Administration
When to Use Emergency Oxygen
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When to Use Emergency Oxygen
Citizen Rescuers
Professional/Healthcare
• Same as citizen rescuers plus:
• Respiratory rates that are
– Heart attack/ACS
too fast or too slow:
– Stroke
– Adult: < 12 or > 20/min.
– Severe asthma
– Child: < 15 or > 30/min.
– Pulmonary embolism
– Infant: < 25 or > 50/min.
• Clot affecting blood supply
to lungs
• No breathing
– Shock
• Cyanosis
– Drowning
• Diving decompression injury
– Pregnancy-related
– Exacerbated COPD
• Lung disease
– Hypothermia
Emergency Oxygen Administration
When to Use Emergency Oxygen
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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 Administration
When to Use Emergency Oxygen
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PATIENT ASSESSMENT
Emergency Oxygen Administration
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Patient Assessment
Assess effort of breathing.
Calculate respirations per minute (RPM).
Signs of Breathing Difficulty
To Calculate a Patient’s RPM
• Labored breathing
• Use stopwatch, second
hand or other timer
• Watch patient’s 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
– Using accessory muscles
in neck and back
– Speaking in broken
sentences
• Noisy breathing
– Coughing
– Wheezing/stridor
• Tripod position
• Cyanosis
Emergency Oxygen Administration
Patient Assessment
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Demo/Practice Session 1
• Skill Demonstration: Patient Assessment
• Skill Practice: Patient Assessment
• Instructions
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Use Practice Sheet
Demonstrate skill, answer questions
Each student practices skill(s)
Use skill sheet to review areas for improvement
Emergency Oxygen Administration
Patient Assessment
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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…
OXYGEN EQUIPMENT
Emergency Oxygen Administration
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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 Administration
Oxygen Equipment
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Cylinders Vary in Size
• Each filled up to about 2015 psi
• Cylinder sizes:
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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 Administration
Oxygen Equipment
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Pressure Regulator
• Connects cylinder valve
to O2 tubing
• Controls rate of flow
(measured in LPM)
• Two types
Oxygen Wrench: Opens cylinder valve
to begin O2 flow into regulator
– Dual flow: high or low
– Full Control: 2 to 25 LPM
• Gauge displays amount
of pressure per sq. inch
– 2000 psi = full
– 1000 psi = ½ full
– 500 psi = time to refill
Emergency Oxygen Administration
Full Control Pressure Regulator
Oxygen Equipment
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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
O-Ring
• Oxygen Tubing
– Connects regulator to O2
delivery device
– Comes in different lengths
– Is pre-connected to delivery
devices
Emergency Oxygen Administration
Oxygen Equipment
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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 Administration
Oxygen Equipment
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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 Administration
Oxygen Equipment
Demand Button
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Oxygen Humidifier
• Not typically used in
emergency settings
• Supplemental O2 can dry
out mucous membranes
of the nose
• Dryness causes irritation
and possible nosebleed
• Humidifier passes O2
through sterile water
• O2 picks up tiny water
molecules, reduces
dryness & irritation
Emergency Oxygen Administration
Oxygen Equipment
31
Pulse Oximeter
• Small, portable
electronic device
• Estimates and monitors
blood-oxygen saturation
level (how much O2 in
blood)
• Uses an infrared probe
• Normal level between
95% and 100%
• Additional training
required for use
Emergency Oxygen Administration
Oxygen Equipment
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Using a Pulse Oximeter
How To Use:
Less effective when:
• Turn on, connect probe to
finger, earlobe or foot/toe
• Register oxygen
saturation level (SpO2)
and pulse rate
• Verify pulse rate on
monitor w/ patient's
actual pulse
• Monitor and record SpO2
• Follow protocols to titrate
based on target O2 levels
• 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
– Typically 94% to 99%
Emergency Oxygen Administration
Oxygen Equipment
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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 Administration
Oxygen Equipment
34
Demo/Practice Session 2
• Skill Demonstration: Connect Pressure Regulator
• Skill Practice: Connect Pressure Regulator
• Instructions
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Use Practice Sheet
Demonstrate skill, answer questions
Each student practices skill(s)
Use skill sheet to review areas for improvement
Emergency Oxygen Administration
Oxygen Equipment
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The delivery device is connected to oxygen tubing, then attached to
the nipple of the pressure regulator.
DELIVERY DEVICES
Emergency Oxygen Administration
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Key Concepts
• There are four basic types
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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 Administration
Delivery Devices
37
Non-Rebreather Mask
• ‘High-flow’ device
• Consists of mask, O2
reservoir and tubing
• Delivers oxygen
concentrations
between 90%-100%
with each breath
• Use 15 LPM
Emergency Oxygen Administration
Delivery Devices
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Using a Non-Rebreather Mask
• Connect tubing to
regulator
• Adjust flow rate to
15 LPM
• Listen for flow of O2
• Briefly cover one-way
valve inside mask to
speed up filling
reservoir
• Place over the patient's
mouth and nose
Emergency Oxygen Administration
Delivery Devices
39
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 O2 is restricted,
even though they are getting more than 90% O2
• 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 Administration
Delivery Devices
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Nasal Cannula
• A low-flow device
• Provides between
2 - 6 LPM
• Max concentration
delivered: 44% O2
• Consists of loop of
oxygen tubing, two
prongs for the nostrils
and an adjusting band
Emergency Oxygen Administration
Delivery Devices
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Using a Nasal Cannula
• Connect tubing to
regulator
• Adjust flow rate: 6 LPM
• Listen for flow of O2
• Open cannula loop
• Holding loop w/ thumb
and forefinger, insert
prongs into nose
• Wrap each side around
patient’s ears
• Slide adjusting band up
• Instruct the patient to
breathe in through nose
Emergency Oxygen Administration
Delivery Devices
42
Bag Mask
• 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
Emergency Oxygen Administration
Delivery Devices
43
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 Administration
Delivery Devices
44
Components of a Bag Mask
• Bag masks use
positive pressure to
push air into the lungs
w/ each squeeze of
the bag
• A bag mask consists
of
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Rigid face mask
Self-inflating bag
Oxygen reservoir
Oxygen tubing
Emergency Oxygen Administration
Delivery Devices
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Using a Bag Mask w/ O2
• Follow guidelines for
CPR/AED & activating
EMS
• Assemble mask, bag
and tubing
• Connect tubing to
oxygen source
• O2 flow of 15 LPM
• Use bag mask to give
rescue breaths
• Reservoir does not Ensure a good seal between face and mask
need to inflate
Emergency Oxygen Administration
Delivery Devices
46
CPR Mask with 02 Inlet
• Used for rescue
breathing
• Increases oxygen
delivery w/ mouth-tomask rescue breaths
• Can deliver up to 55%
oxygen
• Available in adult,
child, infant sizes
• Seal tightly to the face
to give breaths
Oxygen Inlet
Emergency Oxygen Administration
Delivery Devices
47
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
• O2 flow of 15 LPM
• Press mask firmly to the face and open airway
• Breathe into mask and watch for chest rise
Emergency Oxygen Administration
Delivery Devices
48
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 Administration
Delivery Devices
49
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 Administration
Delivery Devices
50
“Blow By” Oxygen Delivery
• For infants and small children who can’t 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 Administration
Delivery Devices
51
Demo/Practice Session 3
• Skill Demonstration: Delivery Devices
• Skill Practice: Delivery Devices
• Instructions
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Use Practice Sheet
Demonstrate skill, answer questions
Each student practices skill(s)
Use skill sheet to review areas for improvement
Emergency Oxygen Administration
Delivery Devices
52
RISKS ASSOCIATED W/ OXYGEN
DELIVERY
Emergency Oxygen Administration
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Risks of Oxygen Delivery
• Potential risks related to oxygen delivery
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Oxygen Toxicity
Retinopathy of Prematurity
Denitrogenation
COPD and the Hypoxic Drive
Emergency Oxygen Administration
Oxygen Risks
54
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 Administration
Oxygen Risks
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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 Administration
Oxygen Risks
56
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 O2, 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 Administration
Oxygen Risks
57
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 O2 levels
and to NOT breathe with higher O2 levels
– Concern that emergency oxygen can eliminate the hypoxic
drive of a COPD patient, causing person to stop breathing
• General rule:
– Always give emergency O2 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 O2
Emergency Oxygen Administration
Oxygen Risks
58
GENERAL GUIDELINES FOR
EMERGENCY OXYGEN
DELIVERY
Emergency Oxygen Administration
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General Guidelines
• Guidelines for the delivery of emergency O2
include the following:
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Monitor delivery
Understand the use of oxygen in resuscitation
Train emergency responders
Follow federal, state and local regulations
Emergency Oxygen Administration
Guidelines for Oxygen Delivery
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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 Administration
Guidelines for Oxygen Delivery
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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 SpO2 of 94%-99%
Emergency Oxygen Administration
Guidelines for Oxygen Delivery
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Training for Emergency O2 Use
• The Organization’s 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 Administration
Guidelines for Oxygen Delivery
63
OXYGEN SAFETY
Emergency Oxygen Administration
64
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 Administration
Oxygen Safety
65
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 Administration
Oxygen Safety
66
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 125oF, prolonged exposure to direct sunlight,
or exposure to other heat sources (e.g. radiator,
space heater)
Emergency Oxygen Administration
Oxygen Safety
67
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 Administration
Oxygen Safety
68
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 Administration
Oxygen Safety
69
Storage
What is wrong with this picture?
Emergency Oxygen Administration
Oxygen Safety
70
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 Administration
Oxygen Safety
71
Suction Devices and Airway Adjuncts…
OPTIONAL TOPICS
Emergency Oxygen Administration
72
Suctioning & Airway Adjuncts
• Objectives
– Identify equipment associated w/ the use of
emergency oxygen and airway management
• Key Concepts
– It’s 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 Administration
Suction Devices & Airway Adjuncts
73
Suction Devices
Portable Suction Device
Emergency Oxygen Administration
• Remove blood,
secretions or vomit
from the airway
• Manual, battery
operated (portable)
and bedside
• Tip (catheter) may be
rigid or flexible
Suction Devices & Airway Adjuncts
74
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
Rigid Suction Tip
Flexible Suction Tip
Emergency Oxygen Administration
Suction Devices & Airway Adjuncts
75
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 Administration
Suction Devices & Airway Adjuncts
76
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/AED
Suction Devices & Airway Adjuncts
77
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/AED
Suction Devices & Airway Adjuncts
78
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/AED
Suction Devices & Airway Adjuncts
79
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 SpO2 94-99%
Emergency Oxygen Administration
Conclusion
80