Oxygen Therapy: Emergency Use

by Dynamix Group Writer

Oxygen treatment is crucial in healthcare, and most people are familiar with the idea, having seen nasal cannulas, a venturi mask or a simple face mask. Emergency oxygen is used by ambulance services, and is life-saving. Indications for requirement are respiratory failure, wherein there is inadequate oxygenation or elimination of carbon dioxide from mixed venous blood. Another indication is severe hypoxaemia, which results from ischaemic heart disease, trauma or sepsis.

When used incorrectly though, oxygen can have dire consequences for the patient, and can even be fatal. Underuse of oxygen may expose patients who are critically ill to the risk of hypoxic organ damage. Overuse can also have adverse effects, especially in the case of premature infants and those who have carbon dioxide-retaining conditions such as chronic obstructive pulmonary disease (COPD).

It is important to understand the role of oxygen in blood to know its importance and the purpose it serves. Haemoglobin is a protein that is made up of four protein chains, and at the centre of each chain there is a haem group which contains iron. Oxygen binds to the four iron ions of the haemoglobin molecule and circulates the body. The ability of haemoglobin to bind to oxygen is known as oxygen saturation, or SO_2.This can be measured directly from an arterial blood sample.

The use of oxygen in emergencies to correct hypoxaemia is the only evidence-based indication, and it isn’t used to alleviate breathlessness in patients who are non-hypoxaemic. However if there is a sudden decrease of more than 3% in SO_2,there may be a need for further assessment, as this may be indicative of acute illnesses, such as exacerbations of asthma, COPD or myocardial infarction.

When there is a need for emergency oxygen, the oxygen should be prescribed as soon as possible and started immediately. In other situations, oxygen must be prescribed according to the legal prescription. The healthcare professionals that administer the oxygen therapy, which would usually be a nurse or physiotherapist, must be fully trained and follow the local or national protocols. This will help in ensuring safe prescribing as well as administration of oxygen.

The saturation of oxygen should be checked by pulse oximetry. It should also be supplemented by arterial blood gases tests if necessary, for at least five minutes after the oxygen starts and within half an hour after initiation. If the oxygen saturation falls below the target saturation, and the patient is unstable, then the treatment must be reviewed. If the oxygen saturation and above the target range, and the patient is stable, then delivery system and oxygen flow rate should be reduced.

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