Get certified in ACLS for just $195.00.
To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
[THE DRUG AND ITS EFFECTS] Oxygen, an atmospheric gas increases saturation of hemoglobin oxygen and when used at therapeutic concentrations may aid the oxygenation of certain tissues. [INDICATIONS] The primary indications for the use of oxygen in ACLS are for any suspected cardiac or respiratory emergency, particularly when there are concerns of shortness of breath or suspected ischemic pain. Specifically, for a patient with acute coronary syndrome, we may consider oxygen until the patient is stable, and we should consider continuing oxygen therapy if there is evidence of pulmonary congestion, ongoing ischemia, or if the oxygen saturation drops below 90%. For patients with a suspected stroke, oxygen is only indicated for those with hypoxemia where arterial oxygen saturation is below 94%, and may be considered if the saturation level is unknown or who have a poor clinical presentation. During an active cardiac arrest, we provide 100% oxygen to maximize delivery during low-flow states. Once we achieve ROSC, our goal shifts to use the minimal amount needed to maintain an oxyhemoglobin saturation between 90% and 98%. Now, the reason we are so cautious with over-oxygenation in all patients is due to the concern of hyperoxia which can actually trigger harmful hemodynamic effects. It’s been shown to cause direct vasoconstriction across multiple organ beds, including a decrease in blood flow to the heart and brain. [PRECAUTIONS AND CONTRAINDICATIONS] There are few if any known contraindications for oxygen use in the true hypoxic patient. Since giving oxygen to everyone is not appropriate, our precautions focus on specific assessment findings that could lead us to withhold or misapply treatment. Here are a few examples to watch for. If a patient was exposed to carbon monoxide, they might have a pulse oximetry of near 100%, but since the CO replaces oxygen on the hemoglobin, this patient would still be hypoxic and require high-flow oxygen. If a patient has a history of COPD, then it is appropriate to titrate oxygen back to their normal O2 saturation, usually between 88% and 92%. Expecting to achieve higher levels may be harmful. There are reasons your pulse oximetry reading itself might be incorrect: Low blood flow, such as in a patient who is in shock, or simply someone with cold hands that shunt blood away from the fingers. Anemia - where the patient has overall low hemoglobin levels but may still show a normal hemoglobin saturation percentage. [ADULT DOSAGE] Oxygen has several different methods for delivery and the percentage of oxygenation is regulated by the flow of oxygen per minute and the delivery adjunct used. Now if oxygen delivery by nasal cannula is indicated, it would be delivered at a rate of 2 to 6 liters per minute. If a nonrebreather mask is used the flow rate increases to 12 to 15 liters per minute. If the respiratory depressed or those who are apneic completely, the delivery of oxygenated ventilations would be delivered via a positive pressure device like a bag valve mask. In this case, oxygen flow should be set at 15 liters a minute. It’s vital to remember that a restricted airway will affect the therapeutic response of the oxygenation treatment. Use of a basic or advanced airway adjunct may be needed in order to open or maintain an open and patent airway in order to treat the patient effectively. Now remember to monitor the patient’s signs and symptoms along with the electronic and technical monitoring systems so as to treat the patient effectively.
In this lesson, we'll cover oxygen therapy and all of its clinical effects, including its mechanism of action, indications, precautions, contraindications, and adult dosages.
Oxygen, an atmospheric gas, increases the saturation of hemoglobin oxygen. When used at therapeutic concentrations, it serves to aid the oxygenation of body tissues.
The primary indications for the use of oxygen in ACLS are for any suspected cardiac or respiratory emergency, particularly when there are concerns of shortness of breath or suspected ischemic pain. Look to the following clinical guidelines:
We are extremely cautious with over-oxygenation in all patients due to the clinical concern of hyperoxia. Hyperoxia can trigger harmful hemodynamic effects and has been shown to cause direct vasoconstriction across multiple organ beds, including a significant decrease in blood flow to both the heart and the brain.
There are few if any known contraindications for oxygen use in the true hypoxic patient. However, since giving oxygen to everyone is not appropriate, healthcare provider precautions should focus on specific assessment findings that could lead us to withhold or misapply treatment:
Pro Tip #1: Carbon Monoxide Exposure: If a patient was exposed to carbon monoxide, they might present with a pulse oximetry reading near 100%. Because CO replaces oxygen on the hemoglobin molecules, this patient is still severely hypoxic and requires immediate high-flow oxygen regardless of the electronic reading.
Pro Tip #2: COPD History: If a patient has a known history of COPD, it is appropriate to titrate oxygen back to their normal baseline O2 saturation, which is usually between 88% and 92%. Attempting to achieve higher standard saturation levels may be harmful to their respiratory drive.
Be aware that your technical pulse oximetry reading itself might be incorrect or misleading due to the following physiological factors:
Oxygen has several different delivery methods, and the percentage of oxygenation is regulated by both the flow rate per minute and the specific delivery adjunct used:
Pro Tip #3: Always remember that a restricted airway will severely affect the therapeutic response of your oxygenation treatment. The prompt use of a basic or advanced airway adjunct may be required to open or maintain a patent airway and treat your patient effectively.