Oxygen

Question 1

Pharmacology and presentation of Oxygen?

Answer 1

Gas via portable C or CD cylinder and vehicle D cylinders

A colourless, odourless gas essential for the production of cellular energy.

Question 2

Indicators of Oxygen?

Answer 2

• Correction or management of hypoxaemia as indicated within CPGs.
• ‘On spec’ at highest concentration possible for Carbon Monoxide poisoning

Question 3

Contraindications of Oxygen?

Answer 3

• Paraquat poisoning with SpO2 >88%
• Bleomycin therapy with SpO2 >88%.

Question 4

Cautions of Oxygen?

Answer 4

• Prolonged administration to premature neonates
• Lung injury may occur if oxygen given to Paraquat and Bleomycin patients – avoid oxygen unless SpO2 falls below 88%
• Caution with STEMI and SpO2 >94%.

Question 5

Side Effects of Oxygen?

Answer 5

• Hypoventilation in some COPD patients
• Drying oral mucosa.

Question 6

Dosing Regimes of Oxygen?

Answer 6

Aim for 100% SpO2
- Cardiac arrest / resuscitation, Shock, Sepsis, Major trauma, Trauma in pregnancy, Near-drowning, Anaphylaxis, Major pulmonary haemorrhage, Major head injury, Carbon monoxide poisoning, Active seizure, Hyperkalaemia & Ketamine Sedation

Aim for at least 92–96% SpO2
- Acute hypoxaemia (unknown cause), Acute asthma, Pneumonia, Lung cancer, Post-operative breathlessness, Acute heart failure, Pulmonary embolism, Pleural effusion/s, Deterioration of lung fibrosis or other interstitial lung disease, Severe anaemia, Pneumothorax & Sickle cell crisis

Aim for 88–92% SpO2
- COPD, Exacerbation of cystic fibrosis, Chronic neuromuscular disorders, Chest wall disorders & Morbid obesity

Manage if falls below 92–96% SpO2
- AMI / ACS, Pregnancy and obstetric emergencies, Stroke, Headache, Post convulsion, Abdominal pain, Hyperventilation or dysfunctional breathing, Poisoning and drug overdoses, Poisoning with Paraquat or Bleomycin therapy (88%), Metabolic and renal disorders, Heat exhaustion/stroke, Cardiac rhythm disturbances, Non-traumatic chest pain & GI Haemorrhage

Question 7

Onset and notes of Oxygen?

Answer 7

• Onset = Immediate
• Must be run at or above manufacturer-specified minimum flow rates to prevent hypercapnoea and possible asphyxia
• Titrate delivery and rate to desired effect.