Oxygen
Oxygen
Required for life
February 7, 2025
Welcome to UH EMS-I’s weekly Pharmacy Phriday CE offering. During the month of February, UH EMS-I’s CE lecture topic, prepared by Kathrina Consing, MD, MS, focuses on respiratory emergencies. Throughout the month, we will use this forum to focus on some of the various medications involved with those algorithms. This week we begin with one of the most common medications administered by EMS personnel, Oxygen.
Oxygen is indicated within the protocols for many situations besides respiratory complaints or shortness of breath. Some of these include cardiac chest pain, stroke, and trauma just to name some of the more common ones. It is a gas that is essential to converting glucose to energy for use by the cells and necessary for life. It is readily available in the normal environment for the healthy person. However, in some cases hypoxia may occur and supplemental Oxygen must be administered.
Hypoxia is a low level of oxygen in the body’s tissues. In assessing a patient for hypoxia, one might look for symptoms such as confusion, restlessness, difficulty breathing, rapid heart rate, and cyanosis. Vital signs, including pulse oximetry, can also be used in assessing a patient for hypoxia. As a general rule, UH protocols recommend supplemental oxygen be administered to maintain an SpO2 of 94% or higher (unless a specific algorithm requires otherwise).
In this month’s CE lecture, Dr. Consing points out to providers that in cases of COPD, typical goals for Oxygen saturations are usually 88-92%. Efforts to achieve higher saturations can be unrealistic and sometimes harmful to the patient due to hypoxic drive and hypercapnia. It is important to be reminded that higher saturations in some of these patients can lead to a higher mortality rate [1]. A take home point to remember is if the patient requires supplemental Oxygen, it does not make sense to withhold the treatment but remember that saturations near 92% are acceptable. Hyperoxia for no specific reason should be avoided.
In some cases, hyperoxia is recommended. You might recall CE education from last year that stressed just such instances. In cases of the head injured patient with evidence of a traumatic brain injury the provider should administer 100% Oxygen. Hypoxia and hypo perfusion are very detrimental for the TBI patient, even for a brief period. The brain is very sensitive to hypoxia and hypo perfusion, and secondary injury and permanent brain damage can occur within minutes of such events. In reviewing our UH protocols, other algorithms that are specific about administering 100% Oxygen included CHF, PE, and toxic inhalation.
Remember that there are many factors involved in providing adequate oxygen to the cells for aerobic metabolism. Oxygen concentrations provided are just one of those factors. Ventilation, or the movement of air is also necessary, as is respiration, or the exchange of gases by the cells and blood, both externally and internally. Management of hypoxia can, and often does, include care beyond simply providing supplemental oxygen.
When providing supplemental Oxygen, administration is normally accomplished in the pre-hospital setting via the nasal cannula (1-6 lpm, achieving 24%-44% concentrations), the non-rebreather mask (up to 15 lpm achieving upwards of 90% concentrations), or the Bag Valve Mask (15 lpm achieving 90% to near 100% concentrations). Another means of providing supplemental oxygenation as well as providing ventilatory support for some respiratory emergencies is the use of continuous positive airway pressure (CPAP) therapy.
Finally, remember that regardless of how much Oxygen one administers or how it is administered, continuous reassessment of the patient and the effects of our care are critical. Monitoring vitals, ECG, pulse ox, and capnography are essential.
Till the next installment of Pharmacy Phriday, stay safe!
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[1] https://pubmed.ncbi.nlm.nih.gov/33243839/
Sincerely,
The UH EMS-I Team
University Hospitals
February 16, 2024
Welcome to UH EMS-I’s weekly Pharmacy Phriday CE offering. As mentioned in the last installment, February is National Heart Month. We hope you were able to check out the episodes already posted of this month’s Prehospital Paradigm series focusing on the care of our STEMI patients. Click here to see more.
Aspirin, Heparin, and Ticagrelor are early medications considered in the treatment of the Acute Coronary Syndrome (ACS) protocol. Another medication considered early within that protocol is oxygen. That is the focus of this week’s installment of Pharmacy Phriday.
Oxygen is a common medication administered by EMS personnel as it has many indications within the protocols that include cardiac chest pain, stroke, respiratory problems, shortness of breath, and trauma, just to name some of the more common ones. It is a gas essential to converting glucose to energy for use by the cells and necessary for life. It is readily available in a normal environment for a healthy person. However, in some cases, hypoxia may occur, and supplemental oxygen must be administered.
Hypoxia is a low level of oxygen in the body’s tissues. In assessing a patient for hypoxia, one might look for symptoms such as confusion, restlessness, difficulty breathing, rapid heart rate, and cyanosis. Vital signs, including pulse oximetry, can also be used in assessing a patient for hypoxia. As a general rule, UH protocols recommend supplemental oxygen be administered to maintain a SpO2 of 94% or higher (unless a specific algorithm requires high flow O2). If assessment findings indicate hypoxia, if the patient complains of shortness of breath, if the provider is unsure, or if saturation readings are not available, give supplemental oxygen.
Another protocol change for 2024 includes a circumstance where high concentrations of oxygen are required, such as in the case of the head-injured patient. When evidence of a traumatic brain injury (TBI) exists or is suspected, and the patient presents with a Glasgow Coma Scale (GCS) of less than 15 or an altered mental status, providers should give 100% oxygen.
Hypoxia and hypo perfusion are very detrimental for the TBI patient, even for a brief period. The brain is very sensitive to hypoxia and hypoperfusion, and secondary injury and permanent brain damage can occur within minutes of such events.
“TBI patients who were hypoxic or hypotensive at any point had much worse outcomes than those who received enough oxygen in a 2017 study published in the Annals of Emergency Medicine. The study found that when patients were both hypoxic and hypotensive, their adjusted odds ratio was 6.1. It means that pre-hospital patients who had at least one SBP measurement less than 90 mmHg and at least one SpO2 below 90% were 6.1 times more likely to die. Hypoxia alone increased the odds of mortality by 3, while hypotension alone increased the odds by 2.5. Ensuring that patients are adequately oxygenated and perfusing is crucial to patient care and this pre-hospital treatment will greatly affect their overall outcome.”
Remember that there are many factors involved in providing adequate oxygen to the cells for aerobic metabolism. Oxygen concentrations provided are just one of those factors. Ventilation, or the movement of air is also necessary, as is respiration, or the exchange of gases by the cells and blood, both externally and internally. Management of hypoxia can, and often does, include care beyond simply providing supplemental oxygen.
When providing supplemental oxygen, administration is normally accomplished in the pre-hospital setting via the nasal cannula (1-6 lpm, achieving 24%-44% concentrations), the non-rebreather mask (up to 15 lpm, achieving upwards of 90% concentrations), or the Bag Valve Mask (15 lpm achieving 90% to near 100% concentrations). Another means of providing supplemental oxygenation as well as providing ventilatory support for some respiratory emergencies is the use of continuous positive airway pressure (CPAP) therapy.
Till the next installment of Pharmacy Phriday, stay safe!
Sincerely,
The UH EMS-I Team
University Hospitals
March 3, 2023
Dear Colleagues,
Welcome to UH EMS-I’s weekly Pharmacy Phriday CE offering. In this week’s edition, we look at the number one medication given in the year 2022 (according to statistics taken from our Health EMS documents). That number one drug was Oxygen!
It is not surprising that Oxygen ranks at the top of medications given, considering it is the primary medication for treating most respiratory problems, one of the top three chief complaints most EMS systems respond to. And as discussed in the Geriatric Trauma CE lectures from February of 2023, Oxygen administration is also an important part of the care provided in trauma and shock, another in the top three complaints seen by EMS.
Oxygen is a gas essential to converting glucose to energy for use by the cells and necessary for life. It is readily available in a normal environment for the healthy person. However, hypoxia may occur in some cases, and supplemental Oxygen must be administered.
You may recall that hypoxia is a low level of Oxygen in the body’s tissues. In assessing a patient for hypoxia, one might note symptoms such as confusion, restlessness, difficulty breathing, rapid heart rate, and cyanosis. Vital signs, including pulse oximetry, can also be used in assessing a patient for hypoxia. As a general rule, UH protocols recommend supplemental oxygen to maintain a SpO2 of 94% or higher (unless a specific algorithm requires high flow O2). If assessment findings indicate hypoxia, if the provider is unsure, or if saturation readings are not available, give supplemental Oxygen.
It is important to remember there are many factors involved in providing adequate Oxygen to the cells for aerobic metabolism. Oxygen concentrations provided, or the fraction of inspired Oxygen (FIO2), is just one of those factors. Ventilation, or the movement of air, is also necessary, as is respiration, or the exchange of gases by the cells and blood, both externally and internally. Management of hypoxia can, and often does, include care beyond simply providing supplemental oxygen.
When providing supplemental Oxygen, administration is normally accomplished in the prehospital setting via the nasal cannula (1-6 lpm, achieving 24%-44% concentrations), the non-rebreather mask (up to 15 lpm achieving upwards of 90% concentrations), or the Bag Valve Mask (15 lpm achieving 90% to near 100% concentrations).
Another means of providing supplemental oxygenation as well as providing ventilatory support is the use of continuous positive airway pressure (CPAP) therapy. Be sure to tune into UH’s Prehospital Paradigm Podcast for more information on CPAP.
https://www.youtube.com/channel/UCcsOP43HVnXT_DbmjktMgHQ
In our next Pharmacy Phriday installment, we will review the #2 medication administered in 2022. What medication do you believe we will be talking about?
Until then, stay safe! And don’t forget to turn your clocks ahead this weekend. Daylight Savings Time begins this weekend, March 12th, 2023, at 0200 hours.
Sincerely,
The UH EMS-I Team
University Hospitals
March 10, 2023
Dear Colleagues,
Welcome to UH EMS-I’s weekly Pharmacy Phriday CE offering. In this week’s edition, we look at the number one medication given in the year 2022 (according to statistics taken from our Health EMS documents). That number one drug was Oxygen!
It is not surprising that Oxygen ranks at the top of medications given, considering it is the primary medication for treating most respiratory problems, one of the top three chief complaints most EMS systems respond to. And as discussed in the Geriatric Trauma CE lectures from February of 2023, Oxygen administration is also an important part of the care provided in trauma and shock, another in the top three complaints seen by EMS.
Oxygen is a gas essential to converting glucose to energy for use by the cells and necessary for life. It is readily available in a normal environment for the healthy person. However, hypoxia may occur in some cases, and supplemental Oxygen must be administered.
You may recall that hypoxia is a low level of Oxygen in the body’s tissues. In assessing a patient for hypoxia, one might note symptoms such as confusion, restlessness, difficulty breathing, rapid heart rate, and cyanosis. Vital signs, including pulse oximetry, can also be used in assessing a patient for hypoxia. As a general rule, UH protocols recommend supplemental oxygen to maintain a SpO2 of 94% or higher (unless a specific algorithm requires high flow O2). If assessment findings indicate hypoxia, if the provider is unsure, or if saturation readings are not available, give supplemental Oxygen.
It is important to remember there are many factors involved in providing adequate Oxygen to the cells for aerobic metabolism. Oxygen concentrations provided, or the fraction of inspired Oxygen (FIO2), is just one of those factors. Ventilation, or the movement of air, is also necessary, as is respiration, or the exchange of gases by the cells and blood, both externally and internally. Management of hypoxia can, and often does, include care beyond simply providing supplemental oxygen.
When providing supplemental Oxygen, administration is normally accomplished in the prehospital setting via the nasal cannula (1-6 lpm, achieving 24%-44% concentrations), the non-rebreather mask (up to 15 lpm achieving upwards of 90% concentrations), or the Bag Valve Mask (15 lpm achieving 90% to near 100% concentrations).
Another means of providing supplemental oxygenation as well as providing ventilatory support is the use of continuous positive airway pressure (CPAP) therapy. Be sure to tune into UH’s Prehospital Paradigm Podcast for more information on CPAP.
https://www.youtube.com/channel/UCcsOP43HVnXT_DbmjktMgHQ
In our next Pharmacy Phriday installment, we will review the #2 medication administered in 2022. What medication do you believe we will be talking about?
Until then, stay safe! And don’t forget to turn your clocks ahead this weekend. Daylight Savings Time begins this weekend, March 12th, 2023, at 0200 hours.
Sincerely,
The UH EMS-I Team
University Hospitals