In EMS we are sometimescalled to a patient that appears in respiratory distress. Once we arrive onscene we must provide oxygen to our patient to prevent the patient fromdeclining. Sometimes the 911 call can be for trauma and cardiac, and we provideoxygen just because of the MOI. The best oxygen therapy for a patient that isnot in respiratory arrest would be a non-invasive airway and breathing device.Just some of our devices include the use of a partial rebreather, a simple facemask, and an venturi mask.
The decision on which device to use should be basedon protocol for the patients complaint, and at EMS discretion on if its appropriatefor that patient. A partial rebreathermask is a simple face mask with a reservoir bag attached to it. The partial rebreathershould be used with 8-15L of oxygen to assure that the bag is at least 1/2 fullduring inspiration. The partial rebreather provides a range of 40% to 70% ofFiO2. The risk of the partial rebreather is the build-up and inhalation of the exhaledCO2. The indication for the partial rebreather is hypoxia, shock, trauma, and ofcourse a respiratory illness. Anotherdevice that can be used is a simple face mask. A simple face mask should be usewith 5-12L of O2, with a FiO2 delivery range of 30-60% O2 depending of the setflow rate, and depth of breathing.
The minimum O2 flow should be 5LPM to preventrebreathing of exhaled air. The simple face mask should only be usedtemporarily to prevent CO2 intake. The simple face mask should only be used inmild respiratory cases. The venturi mask provides the most adequate oxygenwithout intubation. The mask is a high flow device, and delivers between 24%-50%of FiO2. The set flow rate also is determined by the FiOS adapter. The mask is usedby using a portion of room air to each liter flow of oxygen.
The FiO2 adaptershave different size holes in them, which allows a certain amount of air to mixin with the oxygen being provided. Each FiO2 adapter uses a different O2 flow. Theonly problem with the venturi mask is that when the FiO2 increases the air tooxygen ratio decreases, especially after 35%.
For example, a patient with 60%of FiO2 on 12L of O2 is only receiving a total flow of 24LPM. This mask doesnot require humidification. I would use this mask on a patient that is in respiratorydistress, and at a high risk of going into respiratory failure. These devices are just a few that can be used in themedical field. All of them provide adequate oxygen to a patient that is needingoxygen therapy. You can use that patient’s oxygen saturation levels to assure thatthe patient is getting the adequate amount of oxygen, and can also use capnographyto assure adequate ventilation, and to also determine if the patient isexhaling CO2 with expiration. While providing oxygen therapy, you shouldencourage the patient to take deep breaths, to ensure intake of oxygen, anddecrease anxiety level.
Vital signs should be obtained during and after oxygen therapyto ensure that the patient is responding well, and that you are providing thebest device for the crisis. You should listen to lung sounds as part of thevitals signs on a patient that appears in respiratory distress, this will provideyou with a little information on what the patient is experiencing, and if theoxygen is helping with the issues. A patient that is experiencing a respiratorycrisis is at risk of hypoxia, in which causes multiple other issues once itoccurs. Oxygen should be provided during your medical assessment as soon as younotice the patient is in distress. Other steps should be taken if you noticethe patient is no longer in respiratory distress, but is now experiencing respiratoryarrest. You should monitor you patient closely while providing oxygen duringtransportation.