Oxygen administration quick facts

An 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).

oxygen tank: fixed flow oxygen delivery device 80 pixels:

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 victims 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 victims 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 victims 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 childs or infants 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 victims 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 victims
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 valves closed even if the tank is empty. Store oxygen tanks
below 125F.

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 heavy 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 release 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 variable 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:

Isnt oxygen a prescription item? Can a trained lifeguard or first responder administer oxygen
without a doctors 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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The following is an Oxygen administration skills checkoff list including steps for use of an
oxygen tank and the main things to remind students of as they are being tested. This is not
complete instruction in the use of oxygen. These steps do not apply to all makes/models of
tanks/bags. Everyone should follow manufacturers instructions and local protocals.

(remind the student that the tank is a potential hazard and must not be left standing up by
itself, they should direct the working end away from others when working with it, if lying flat on
the floor it can be placed on a towel so it won't roll)

_____check to see if labeled Oxygen (green with yellow diamond)

_____ clear valve by first removing protective covering (remove covering and save plastic
gasket if present)

(REMIND student: Do not point it at anyone, or look into it or put hand over it)

_____ open cylinder for about one second (counterclockwise / lefty-loosy = removes and dirt or
debris)

Attach oxygen pressure regulator

_____ (check to be sure pressure is at zero and flow meter off)

_______ replace plastic O ring gasket into the large valve opening at the top of the cylinder - if
needed

_______ check if regulator is for use with oxygen (see labeling)

______ place regulator on cylinder (slip it down)

_____ find the prongs on the regulator and seat them into the valve

_______ hand-tighten the screw until the regulator is snug (fairly tight)

(REMIND student: do not look closely at meter at this point in case it comes off)

________ SLOWLY open the cylinder one full turn (should not hear air leaking- release pressure
on dial if you have to undo it)

________ check the pressure gauge to determine how much pressure is in the cylinder

(full - 2000 psi to go out on a call, above 500 is okay, 200 is 'empty')

____ attach delivery device and tubing to the flowmeter

_______adjust the flowmeter (clockwise) to the appropriate rate on dial or in window

(Review w/student: cannula 1 to 6 lpm (use only if victim can't tolerate mask on face- in
emergency they need more oxygen), Pocket mask 6-15 , Non-rebreather mask = 10 -15 =
conscious victim, BVM 15 or more, infant = no mask, wave in front of nose = 'blow-by' delivery)

____ verify O2 flow by listening and feeling for oxygen flow thru the delivery device

______(If non-rebreather - inflate the reservoir bag by putting finger over the one-way valve in
the mask)

________ place device on victim

________(did student explain to conscious victim first?)

(If claustrophobic have them hold on to mask instead of using elastic around head)

(If BVM If victim is breathing at (adult) less than 12 breaths per minute or more than 20 per
minute needs assistance of rescuer squeezing bvm as victim breaths (child 15 - 30, infant 25 -
50) (IF NON-rebreather - bag should not collapse fully while in use)

Disassemble

____ remove from face (____ did student first explain to conscious victim?)

____ turn off flowmeter

____ close the cylinder (righty-tighty)

___ turn on flowmeter at bleed line (turn it back to zero)

____ remove regulator

________Be sure the oxygen cylinder is not standing upright unless on a cart -

remind student: do not use with AED,

Do not use around open flame or sparks (oxygen causes fires to burn more rapidly)

Do not use grease, oil or petroleum products to lube any pressure regulator parts (oxygen does
not mix with these and a severe chemical reaction could cause an explosion)