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The Emergency Administration of Oxygen

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The Emergency Administration of Oxygen FEATURE CORE CPD: ONE HOUR Emma Hammett describes when and how The emergency to administer oxygen during an emergency in administration the dental practice. any dental practices hold oxygen for the treatment of acute of oxygen medical emergencies. It is vital to ensure that this is given appropriately to optimise a Mcasualty’s best chance of survival. Oxygen should only be administered by staff who are trained and competent. Guidelines for oxygen administration are set by the British Thoracic Society. In most emergency situations, oxygen is given to patients immediately, without a formal prescription. In all other circumstances, a prescription is essential. When oxygen is given without a prescription in an emergency, a subsequent written record must be made of exactly what oxygen therapy has been given to the casualty, in addition to recording, in writing, the rest of the emergency treatment. Historically, oxygen has been an integral part of the emergency treatment of ill or injured patients. It has been widely believed that oxygen helps the casualty with their breathing. Tis is not the case - oxygen is a drug for the treatment of hypoxaemia, not breathlessness. In a conscious casualty, oxygen should be prescribed according to a target saturation range and those who administer oxygen therapy must monitor the patient closely and keep within the range (Figure 1). CPD questions This article has four CPD questions attached to it which will earn you one hour of verifiable CPD. To access the free BDA CPD hub, go to https://cpd.bda.org/ login/index.php Fig. 1 Checking oxygen saturation ©Image credit / Getty Images Plus ©Image credit with a pulse oximeter 14 BDJ Team www.nature.com/BDJTeam FEATURE Giving oxygen to a conscious oximetry in all breathless and acutely ill patients. casualty in an emergency situation Te other vital signs are pulse, blood pressure, Extreme care should be given when temperature and respiratory rate – capillary administering oxygen to a conscious patient refll time is also helpful. Oxygen saturation, and it should ideally only be given whilst closely sometimes referred to as the ffh vital sign, monitoring their oxygen saturation with a pulse should be checked by pulse oximetry in all oximeter. If oxygen saturation levels are less than breathless and acutely ill patients. 94% then oxygen may be indicated. However, if the casualty has pre-existing chronic obstructive Storage and cleaning of your airways disease or is at risk of hypercapnic oxygen cylinder respiratory failure - the indicated pulse oximeter Te most commonly used portable cylinder is saturation level is considerably lower at 88 to the C/D cylinder. It is pressurised to 2000 psi 92%. and contains 450L of Oxygen when full. Oxygen Giving oxygen to these patients with higher tanks should only be cleaned with soap and oxygen saturation could prove fatal. water as cleaning with other products could If a patient’s oxygen saturations demonstrate cause combustion. Oil and petroleum-based that they are hypoxic and they are conscious, products must be stored away from cylinders as oxygen is indicated for the following conditions: they could cause a fre. Myocardial infarction and acute coronary Te gauge on the side of the tank should be conditions regularly checked and the cylinder replaced if Stroke the needle points to the red zone (Figure 2). Cardiac rhythm disturbance Implantable cardioverter defbrillator fring Administering oxygen Glycaemic emergencies. Prior to administration turn the dial on the side of the tank to the fully ‘on’ position. Te Because oxygenation is reduced in the litre fow gauge is found on top of the cylinder supine position, fully conscious hypoxaemic and you should turn this to choose the most patients should ideally be allowed to maintain appropriate litre fow. Oxygen tubing should the most upright posture possible, or the most be securely connected to the ‘Christmas tree’ comfortable posture for the patient. adapter on the top (Figure 3). Oxygen saturation, sometimes referred to as Oxygen is highly fammable so be extremely the ffh vital sign, should be checked by pulse careful using it if there is a fre at the scene of an incident and during defbrillation. Oxygen Fig. 3 Oxygen cylinder front should be moved away by at least an arm’s length and back ‘OXYGEN SHOULD ONLY BE ADMINISTERED BY STAFF WHO ARE TRAINED AND COMPETENT. GUIDELINES FOR OXYGEN ADMINISTRATION ARE SET BY THE BRITISH THORACIC SOCIETY.’ prior to administering a defbrillating shock. one-way valve to enable it to fll. Te reservoir If the casualty is conscious, low fow oxygen bag should not be completely empty when the can be administered through nasal cannula patient inhales. (nasal specs). Give at a rate of 1-6L/min. Both the nasal cannula and the non- Alternatively, you can give oxygen to a rebreather mask are only efective when the conscious casualty through a non-rebreather patient is breathing. mask. Tis can be used to administer high fow oxygen. Tis would be required for the For an unconscious patient – patient spontaneously breathing and displaying administering oxygen using a BVM signs and symptoms of hypoxia with an In an unconscious non-breathing casualty, accompanying low pulse oximetry reading. oxygen should be administered through the It requires a fow rate of 12-15L/min. Prior to bag and valve mask (BVM) (Figure 4). Airway Fig. 2 Oxygen cylinder needs administration the reservoir bag should be adjuncts may be deployed if available and replacing as it is in the ‘red zone’ flled with oxygen by placing a fnger over the appropriately trained staf are able to insert them. www.nature.com/BDJTeam BDJ Team 15 FEATURE Davis P G, Tan A, O’Donnell C P, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta- analysis. Lancet 2004; 364: 1329-1333. Stockinger Z T, McSwain N E. Prehospital Supplemental Oxygen in Trauma Patients: Its Efcacy and Implications for Military Medical Care. Mil Med. 2004; 169: 609-612. Austin M A, Wills K E, Blizzard L, Walters E H, Wood-Baker R. Efect of high fow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ 2010; 341: c5462. Kilgannon JH, Jones AE, Parillo JE, at al. Emergency Medicine Shock Research Network (EMShockNet) Investigators. Relationship between supranormal oxygen Fig. 4 Delivering oxygen through the bag and valve mask (BVM) tension and outcome afer resuscitation from cardiac arrest. Circulation 2011; 123: 2717-2722. For a patient who is unconscious and not or rising concentrations of carbon dioxide. It Harten J M, Anderson K J, Kinsella J, et breathing or struggling with respiratory efort, is vital to carefully monitor the whole patient al. Normobaric hyperoxia reduces cardiac positive pressure ventilation should be initiated and escalate care to the emergency services and index in patients afer coronary artery bypass immediately. If there is no oxygen available, the appropriate advanced care physicians as quickly surgery. J Cardiothorac Vasc Anesth 2005; BVM can be used with room air. as possible. 19: 173–175.McNulty P H, et al. Efects of In order to ventilate a patient efectively; supplemental oxygen administration on tilt the head and lif the chin, or perform a Further reading coronary blood fow in patients undergoing jaw thrust. Maintain a tight seal between the Akero A, Christensen C C, Edvardsen A, cardiac catheterization. Am J Physiol Heart patient’s face and the mask, this is best achieved et al. Hypoxaemia in chronic obstructive Circ Physiol 2005; 288: H1057-H1062. using the C grip. If the patient is unconscious pulmonary disease patients during a Bledsoe B E, Anderson E, Hodnick R, and without a gag refex and airway adjuncts are commercial fight. Eur Respir J 2005; 25: Johnson S, Dievendorf E. Low-fractional available, the airway may be better maintained 725–730. oxygen concentration continuous positive using an Igel, oropharangeal or nasopharangeal Cottrell J J, Lebovitz B L, Fennell R G, et airway pressure Is efective In the prehospital airway, provided you are trained and competent al. Infight arterial saturation: continuous setting. Prehosp Emerg Care 2012; 16: 217- to use them. (nasopharangeal airways can be monitoring by pulse oximetry. Aviat Space 221. used even with a gag refex). Environ Med 1995; 66: 126–130. For an unconscious casualty with a pulse, or Hofman C E, Clark R T, Brown E B. Emma Hammett is a qualified someone with severely depressed respiratory Blood oxygen saturations and duration of nurse and award-winning first function, a ventilation rate of one breath every consciousness in anoxia at high altitudes. Am aid trainer with over 30 years’ 6 seconds is adequate, and success can be seen J Physiol 1946; 145: 685–692. healthcare and teaching when chest rise is observed. Do not over- Alteiemer W A, Sinclair S E. Hyperoxia experience. She is the Founder ventilate, squeeze gently and steadily until chest in the intensive care unit: why more is not and CEO of First Aid for Life, rise is observed. Although ventilation via BVM always better. Curr Opin Crit Care 2007; 13: a multi-award-winning, fully can be accomplished with one rescuer, a greater 73-78. regulated first aid training provider success rate can be achieved with two people. O’Connor R E, Brady W, Brooks S C, Diercks specialising in first aid and One rescuer ensures an airtight seal between the D, Egan J, Ghaemmaghami C, Menon V, medical emergency training for mask and the patient’s face, the second squeezes O’Neil B J, Travers A H and Yannopoulos Dental Practices. the bag every six seconds. D. American Heart Association Guidelines If giving chest compressions in combination for Cardiopulmonary Resuscitation and First Aid for life provides this with the BVM, you should use the ratio of 30 Emergency Cardiovascular Care Science Part information for guidance and it compressions to 2 BVM squeezes.
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