Oxygen administration quick factsAn injured or ill person can benefit greatly from receiving air with a higher oxygen concentration.
The air a person normally breathes contains approximately 21 percent
oxygen. The concentration of oxygen delivered to a victim through
rescue breathing is 16 percent.
Without adequate oxygen, hypoxia, a condition in which insufficient oxygen reaches the cells, will occur.
Signs and symptoms of
hypoxia include
Increased breathing and heart rate.
Changes in level of consciousness.
Restlessness.
Cyanosis (bluish lips and nailbeds).
Chest pain
Always provide emergency oxygen to a victim having difficulty breathing
if it is available, you are trained to use it and local protocols allow.
Emergency oxygen should be considered if
An adult is breathing fewer than 12 breaths per minute or more than
20 breaths per minute.
A child is breathing fewer than 15 breaths per minute or more than
30 breaths per minute.
An infant is breathing fewer than 25 breaths per minute or more than
50 breaths per minute.
To deliver emergency oxygen, you need:
An oxygen cylinder.
A regulator with pressure gauge and flowmeter.
A delivery device, such as a nasal cannula, resuscitation mask, non-rebreather mask or a BVM (more below about these).
 
Some emergency oxygen systems deliver oxygen at a fixed-flow rate. (See picture on the right above.) The delivery device, regulator and cylinder are already connected, which reduces or eliminates need to assemble the equipment making it easier and quicker to deliver emergency oxygen. But you can only deliver at a pre-set rate of either 6 liters per minute with a nasal cannula or 12 lpm with a resuscitation mask or non-rebreather mask.
To operate this type of device, the rescuer makes sure it is turned on,
checks that oxygen is flowing and places the mask over the victim’s
face.
One brand will run for 90 minutes. Another quotes 40 minutes at 6 LPM (liters per minute).
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In the United States, oxygen cylinders are labeled “U.S.P.” and marked
with a yellow diamond that says “Oxygen.”
U.S.P. stands for United States Pharmacopeia and indicates the oxygen
is to be used for medical purposes.
In the United States, oxygen cylinders typically have green markings.
However, the color scheme is not regulated, so different manufacturers
and other countries may use different color markings.
Oxygen cylinders contain gas under high pressure. If mishandled, cylinders
can cause serious damage, injury or death.
Oxygen cylinders come in different sizes and have various pressure
capacities. Cylinders are identified by letter according to their size. Manufacturers stats vary, some say D cylinders hold 350 liters, others 415 E = 625,682 M = 3,000, 1723 G = 5,300, H = 6,900.
At 12 LPM a 415 liter tank will run for an average of 35 minutes.
The regulator reduces the pressure of the gas coming from the cylinder
to a level that is safe for delivering oxygen to a victim.
The pressure gauge shows the pressure in the cylinder in pounds per
square inch (psi).
The O-ring gasket makes the pressure gauge seal tight.
A flowmeter controls the amount of oxygen administered in liters per
minute (LPM).
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Oxygen should be delivered with properly sized equipment for the respective
victims and appropriate flow rates for the delivery device.
Nasal cannula: flow rate 1-6 LPM, 24-44 percent oxygen concentration, breathing victims only
Resuscitation mask: flow rate 6 -15 LPM, 35-55 percent oxygen concentration, breathing and non-breathing victims
Non-rebreather mask: flow rate 10-15 LPM, 90+ percent oxygen concentration, breathing victims only
BVM: flow rate 15 LPM or more, 90+ percent oxygen concentration, breathing and non-breathing victims
A nasal cannula is a plastic tube with two small prongs that are inserted
into the victim’s nose. This device is used to administer oxygen to
a breathing victim with minor breathing problems.
Oxygen is normally delivered through a nasal cannula at a low flow
rate of 1 to 6 LPM.
Nasal cannulas also can be used if the victim does not want a mask
on his or her face.
A resuscitation mask with an inlet valve may be used with emergency
oxygen to give rescue breaths to breathing and nonbreathing victims.
The recommended flow rate when using a resuscitation mask is 6 to
15 LPM.
A non-rebreather mask is an effective method for delivering high concentrations
of oxygen to a breathing victim.
Non-rebreather masks consist of a face mask with an attached oxygen
reservoir bag and a one-way valve, which prevents the victim’s
exhaled air from mixing with the oxygen in the reservoir bag. Flutter
valves on the side of the mask allow exhaled air to escape freely. As
the victim breathes, he or she inhales oxygen from the bag.
Because young children and infants may be frightened by a mask
being placed on their faces, consider a blow-by technique. The
rescuer, parent or guardian should hold a non-rebreather mask approximately
2 inches from the child’s or infant’s face. This will allow
the oxygen to pass over the face and be inhaled.
The reservoir bag should be sufficiently inflated (about two-thirds
full) by covering the one-way valve with your thumb before placing it
on the victim’s face. If it begins to deflate when the victim inhales, increase
the flow rate of the oxygen to refill the reservoir bag.
The flow rate when using this device is 10 to 15 LPM.
A non-rebreather mask can deliver an oxygen concentration of
90 percent or more.
A BVM can deliver up to 100 percent oxygen to a breathing or non-breathing
victim when attached to emergency oxygen.
Squeezing the bag as the victim inhales helps deliver more oxygen.
BVM flow rates should be set at 15 LPM or more.
Take the following precautions when using oxygen:
Always make sure that oxygen is flowing before placing the delivery
device over the victim’s mouth and nose.
Do not use oxygen around flames or sparks. Oxygen causes fire to
burn more rapidly. Do not smoke or let anyone else smoke around oxygen in transport, in use or on standby.
Do not use grease, oil or petroleum products to lubricate or clean the
pressure regulator or any fitting hoses, etc. This could cause an explosion.
Do not stand oxygen cylinders upright unless they are well secured.
If the cylinder falls, the regulator or valve could become damaged or
cause injury.
Do not drag or roll cylinders.
Do not carry a cylinder by the valve or regulator.
Do not hold onto protective valve caps or guards when moving or
lifting cylinders.
Do not deface, alter or remove any labeling or markings on the
oxygen cylinder.
Do not attempt to mix gases in an oxygen cylinder or transfer oxygen
from one cylinder to another.
Never use oxygen without a safe regulator that fits properly.
When the tank is not in use keep vavlves closed even if thetank is empty. Store oxygen tanks below 125°F.
If defibrillating, make sure that no one is touching or is in contact
with the victim or the resuscitation equipment.
Do not defibrillate someone when around flammable materials, such
as gasoline or free-flowing oxygen.
Never drag or roll cylinders.
Carry a cylinder by both hands and never by the valve or regulator.
Do not store oxygen cylinders near flammables or hot water heaters, near electric or phone boxes, where they can have something heaby fall on them, where they could be tipped over or exposed to heat or direct sunlight.
When transporting oxygen cylinders: do not store them in the trunk; secure then in case of a sudden stop, acceleration or sharp turn, when they could become a serious projectile hazard; immediately remove them from the vehiole rather than risk heat exposure which could cause a potentially hazardous relearse of gas.
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Oxygen tank capacities
Capacities of small fixed rate cylinders vary. They all are supposed to have at least a 15 minute supply. Two major brands offer 40 or 90 minutes at 6 LPM.
A larger varible rate tank (the kind you use a regulator with) will hold much more. A typical D size tank, such as the ones we use for training
at De Anza, would hold 350 to 425 to 415 liters
(different manufacturer's stats), and have an
average run time of 138 minutes at 3LPM (liters per minute)
or 35 minutes at 12LPM.
A larger E size would hold 625 to 682 to 684 liters and have an
average run time of 227 minutes at 3LPM or 57 minutes at 12LPM.
You can figure out how much more run time you have left on a given cylinder by using the
mathematical equation:
(Gauge Pressure minus Safe Residual Pressure) times Cylinder
Factor divided by Flow Rate
Tanks start out with 2000 PSI (pounds per square inch) pressure. Most authorities will tell you to refill a tank before it gets down to 200 PSI, the safe residual pressure.
The cylinder factor for a 400 liter D tank is 0.16,
for a 625 liter E tank it's 0.28.
To use the equation: at your pool you have the usual D cylinder. When you
start to use it you see a cylinder pressure of 800 PSI.
You set the flowmeter for the non-rebreather mask for your breathing victim to 15 liters of oxygen
per minute.
How many minutes of oxygen do you have left?
(800 minus 200) times 0.16) divided by 15 = just under 6 and a half minutes
In this instance you might want to get out another tank and get it ready.
(According to the Red Cross, in late 2006, "In Santa Clara County, for example, the average emergency response time from the call to 911 to arrival is about 7 minutes. (Times may vary due in part to traffic delays and the logistics of getting to victims in high-rise buildings.)" )
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Some students ask:
Isn’t oxygen a prescription item? Can a trained lifeguard or first responder administer oxygen without a doctor’s order?
The Red Cross says:
"Emergency oxygen does not require a prescription. The Food and Drug Administration (FDA) regulation of oxygen is defined by the dose and duration of the oxygen administration. According to the FDA, to be classified as emergency oxygen, it must be delivered at a dose of at least 6 liters per minute or run for a duration of more than 15 minutes. In this case it is considered first aid use and does not require a prescription. When the dose of oxygen is delivered for less than 6 liters per minute or for a duration of less than 15 minutes, a prescription for oxygen is required. State and local regulations may differ and should be consulted before allowing lifeguards to administer emergency oxygen."
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see also:
Bloodborne Pathogens quick facts
CPR quick facts
AED quick facts
How to pass a Red Cross written test
Common mistakes in Professional Rescuer CPR skills
CPR Pro skills review questions
First Aid for Public Safety Personnel study guide
Simple secondary survey study sheet
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