EMR ch10

Copyright ©2012 by Pearson Education, Inc.All rights reserved.

Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson

Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley

CHAPTERCHAPTER

Oxygen TherapyOxygen Therapy

1010




1. Define the following terms:a. blow-by methodb. humidifierc. hydrostatic testd. liter flowe. nasal cannulaf. nonrebreather mask g. O ring

(continued)




1. Define the following terms:h. oxygen concentrationi. oxygen supply tubingj. pin index systemk. pressure gaugel. pressure regulatorm. reservoir bagn. supplemental oxygen

(continued)




2. Explain the benefits of supplemental oxygen.

3. Explain the indications of supplemental oxygen.

4. Explain the potential hazards of working with high-pressure cylinders.

5. Explain the safe practices when working with high-pressure cylinders.

6. Differentiate between the common sizes of oxygen cylinders used in EMS.

(continued)




7. Describe the purpose and functions of an oxygen regulator.

8. Explain the indications for the use of a nasal cannula.

9. Explain the indications for the use of a nonrebreather mask.

10.Demonstrate the proper use of a nonrebreather mask.

11.Demonstrate the proper use of a nasal cannula.

(continued)




12.Demonstrate the ability to add supplemental oxygen to a pocket mask and/or bag-mask device.

13.Demonstrate the proper technique for attaching a regulator to a cylinder.

14.Demonstrate the ability to identify and troubleshoot a leaky oxygen cylinder/regulator.

15.Recognize the value that supplemental oxygen might offer for most ill and injured patients.




TopicsTopics

• Importance of Oxygen• Hazards of Oxygen• Oxygen Therapy Equipment• Administering Oxygen




IMPORTANCE OF OXYGENIMPORTANCE OF OXYGEN




Importance of OxygenImportance of Oxygen

• Oxygen is a drug.• The air we breathe contains 21 percent

oxygen.• Supplemental oxygen is 100 percent

oxygen.• Oxygen concentration: amount of

oxygen being delivered to patient.





• Patient may need oxygen for:– Respiratory or cardiac compromise– Cardiac arrest– Shock– Major blood loss– Injury to lungs or chest– Airway obstruction– Stroke





• Common Indicators– Abnormal signs and symptoms– Significant mechanism of injury– Increased level of distress




Think About ItThink About It

• What physiological needs are met by adequate breathing?

• What are some causes of inadequate breathing?

• What are the signs of inadequate breathing?




HAZARDS OF OXYGENHAZARDS OF OXYGEN




Hazards of OxygenHazards of Oxygen

• Oxygen may be under 2,000 pounds per square inch (psi) of pressure (full tank).

• If tank is punctured or valve breaks off, supply tank and valve can become deadly projectiles.




Hazards of OxygenHazards of Oxygen

• Oxygen itself is nonflammable, but it greatly increases rate and intensity of combustion.

• Oxygen and oil do not mix.





• Do not underestimate the dangers of oxygen!

• What safety precautions should the EMR take when working with oxygen cylinders?

• Which placards are used by the U.S. Dept. of Transportation for pressurized oxygen?




OXYGEN THERAPY EQUIPMENTOXYGEN THERAPY EQUIPMENT




Oxygen Therapy EquipmentOxygen Therapy Equipment

• Oxygen-delivery System:– Oxygen source– Regulator– Delivery device

• Oxygen Cylinders– Aluminum cylinders filled with pressurized

oxygen.

(continued)




An oxygen-delivery system.





• Oxygen Cylinders– Various sizes, identified by letters.

D cylinder (425 liters oxygen) Jumbo D cylinder (640 liters oxygen) E cylinder (680 liters oxygen)

(continued)




Various-size portable oxygen cylinders.





• Oxygen Cylinders– Pressure gauge determines pressure

remaining in tank.– Never allow to go completely empty.– Never allow pressure in oxygen cylinder to

fall below 200 psi.





• Oxygen System Safety– Never allow smoking.– Never use around open flames or sparks.– Never use grease or oil.– Never put tape on cylinder.

(continued)





• Oxygen System Safety– Never store near high heat or in a closed

vehicle parked in the sun. – Keep portable cylinders lying flat.– Use pressure gauges and regulators.– Ensure O ring is in good condition.

(continued)





• Oxygen System Safety– Valves/connections hand-tight only.– Open and close all valves slowly.– Store in cool, ventilated room.– Have hydrostatically tested.





• Oxygen Regulators– Pressure in full oxygen cylinder: 2,000 psi.– Regulators have three functions:

Reduce tank pressure Display tank pressure Control delivery of oxygen

(continued)




Pressure regulators, one on and one off the tank.





• Oxygen Regulators– Connecting the Regulator– Pin index system: safety system used to

ensure proper regulator is used for specific gas. Largest pin is oxygen port. O ring ensures airtight seal between

regulator and tank valve.

(continued)




The PIN safety system.





• Oxygen Regulators– Humidifiers

Unbreakable container of sterile water. Oxygen becomes more comfortable for

patient to breathe. Many EMS systems no longer use

humidifiers due to infection risk.





• Oxygen-Delivery Devices– Nasal cannula

Used to deliver low concentrations of supplemental oxygen to breathing patient.

– Nonrebreather mask Used to deliver high concentrations of

supplemental oxygen.

(continued)




Oxygen-Delivery Devices




Example of a nasal cannula.




A nasal cannula properly placed on the face of the patient.





• Oxygen-Delivery Devices– Nonrebreather mask

Face mask, one-way valve, reservoir bag.– Inflate bag before placing on patient's face.– Always ensure adequate oxygen flow (12–

15 lpm).

(continued)




Example of a nonrebreather mask.




A nonrebreather properly placed on the face of a patient.





• Oxygen-Delivery Devices– Venturi mask

Adjustable “jets” that allow user to more accurately determine specific oxygen concentration.

(continued)





• Oxygen-Delivery Devices– Blow-by Delivery

Used for patient who will not tolerate traditional mask or cannula placed on face.

Especially good for small children.





• What is the length of time an oxygen cylinder can be used?

• How often should the oxygen regulator be checked for adequate pressure?




ADMINISTERING OXYGENADMINISTERING OXYGEN




Administering OxygenAdministering Oxygen

• Step-by-step process of preparing oxygen-delivery system and administering oxygen.

• Three devices:– Pocket mask with oxygen inlet– Bag-mask device– Demand-valve device




Remove the plastic wrapper or cap protecting the cylinder outlet.




Keep the plastic washer that is used in some setups.




“Crack” the main valve for one second.




Place cylinder valve gasket on regulator oxygen port.




Tighten T-screw hand-tight. Do not overtighten because this can crush or crack the washer, thus causing a leak.




Attach tubing and delivery device.




Explain the need for oxygen therapy.




Open the main valve.




Attach the delivery device and adjust flow meter.




Be sure to fill the reservoir bag prior to placing it on the patient by turning on the flow and placing your finger over the valve in the

mask.




Position the oxygen-delivery device on the patient.




Secure the cylinder during transfer.





• Pocket Mask with Oxygen Inlet– Delivers higher concentrations of oxygen

than pocket mask alone.• Bag-Mask Device

– Capable of accepting supplemental oxygen.– Works best when used by two rescuers.




One mask without and one with an oxygen inlet.




Rescuer delivering her own breath through the mask's chimney plus oxygen through the inlet. (Photo courtesy of Laerdal Medical

Corporation)




Bag-mask device connected to an oxygen supply.(Photo courtesy of Laerdal Medical Corporation)





• Demand-Valve Device– Delivers oxygen through regulator that can

deliver 100 percent oxygen “on demand” when patient inhales.

– Monitor patient carefully when providing assisted ventilations.





• General Guidelines for Oxygen Therapy– Explain you would like to provide oxygen; it

will help the patient feel better. – Show device; explain how it works; and

how it will fit on face. – Gently place device on face and confirm

patient is comfortable; adjust as necessary.

(continued)





• General Guidelines for Oxygen Therapy– Remind patient to breathe as normally as

possible.– If patient is anxious and reluctant to accept

device, provide extra reassurance.– Monitor patient closely.





• What are the advantages and disadvantages of each type of oxygen delivery device?

• Why is it important, if at all possible, to explain to a patient what you are doing during oxygen administration?

• When is it appropriate NOT to administer oxygen?




SUMMARYSUMMARY




SummarySummary

• Most ill or injured patients will benefit from supplemental oxygen.

• Oxygen is stored and transported in portable containers called cylinders.

• Important to keep high-pressured cylinders lying flat on ground to minimize damage.




SummarySummary

• Cylinders should be stored in cool environment and away from sources of flame or heat.

• Commonly used cylinders in EMS are the D, Jumbo D, and E cylinders.

• Pressure regulator used to reduce pressure of oxygen coming out of cylinder.




SummarySummary

• Two devices used to provide supplemental oxygen:– Nasal cannula can deliver oxygen

concentrations up to 44 percent. – Nonrebreather mask capable of delivering

oxygen concentrations up to approximately 90 percent.




SummarySummary

• Amount of supplemental oxygen provided to patient determined by:– Mechanism of injury– Signs and symptoms– Level of distress




SummarySummary

• When a patient is not breathing adequately, provide positive pressure ventilations.

• Can be performed by using:– Pocket mask.– Bag-mask.– Demand-valve device.




REVIEW QUESTIONSREVIEW QUESTIONS




1. What are the benefits of supplemental oxygen?

2. What are the potential hazards of working with high-pressure cylinders?

3. When working with high-pressure cylinders, what safe practices should you employ?

4. What size oxygen cylinder is commonly carried in an O2 bag by EMS?

(continued)




5. What is the purpose and function of an oxygen regulator?

6. What are the indications for the use of the following:a. Nasal cannula?b. Nonrebreather?c. Pocket mask?d. Bag-mask?




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EMR ch10

Healthcare

Transcript of EMR ch10