- Oxygen is a treatment for hypoxaemia and has not been shown to have any effect on breathlessness in non-hypoxaemic patients.
Adult:
- Oxygen should be titrated to achieve oxygen saturations of between 94 – 98%, (or 88 – 92% for COPD patients). These are achieved through the use of different flow rates and oxygen masks.
Paediatric:
- All paediatric patients with significant illness or injury should receive oxygen. Newborn resuscitation should ideally be commenced with room air for the first couple of breaths.
- Explosive or flammable environments
- Normoxia
- If the target saturations cannot be maintained with the nasal cannula or medium concentration mask then change to a non-rebreather oxygen mask.
- Oxygen increases the toxicity in paraquat poisoning, target saturations of 88–92%.
- Remember that some conditions can affect SpO2 readings e.g. carbon monoxide poisoning and cold digits
- Please review guidance on Nebulisers
- Crews should allow the patient to administer their own Salbutamol MDI via spacer wherever possible
- Allow patient to self-administer Salbutamol per their asthma management plan or under crew direction; stand clear and wait a minute before approaching the patient
- If you have to use SJA supplied Salbutamol MDI, assess whether it can be reused and wipe with Clinell wipe after use. Discard the MDI in the sharps bin if the patient is very unwell or highly symptomatic of infectious respiratory condition.
- Note: If administering St John supplied medication, crews are NOT to leave the remainder of the medication with the patient. This is a violation of the St John WA poisons licence and the Medicines and Poisons Act 2014.
- Crews may tolerate lower oxygen saturations in patients with infective respiratory symptoms prior to considering intervention, as the use of MDI’s may precipitate a cough. See Oxygen for specifics regarding SpO2 tolerance and Oxygen Delivery for COVID-19 precautions.
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- Aim for target saturations of between 94 – 98% for critical conditions requiring supplemental oxygen, maintained via bag-valve-mask or reservoir bag.
- In patients with COPD or other conditions requiring controlled or low-dose supplemental oxygen aim for target oxygen saturations range of 88 – 92% (or the patient’s prescribed range).
- If the patient is hypoxaemic, oxygen saturations of between 94 – 98% should be maintained through the use of a mask or nasal cannulae as appropriate.
At the correct flow rate the following devices will deliver the following approximate FiO2:
| Mask | Fraction of Inspired O2 (FiO2) | Flow-rate |
|---|---|---|
| Nasal cannulae | 24 - 35% | 1 - 4 litres per minute |
| Simple face mask | 40 - 60% | 5 - 8 litres per minute |
| Non-rebreather mask | 60 - 100% | 10 - 15 litres per minute |
| Bag-valve-mask | 100% | 15 litres per minute |
- Patients with acute episodes of COPD are at risk of developing carbon dioxide retention if they are given excessive supplemental oxygen. This can cause acidosis and subsequent organ dysfunction.
- High oxygen concentrations can lead to increased production of reactive free radicals resulting in cellular damage. This may be responsible for the detrimental effects observed with the use of high flow oxygen in myocardial infarction and stroke.
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- "C" size cylinder: 490 Litres
- "D" size cylinder: 1640 litres
See also:
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