Breath of Life: A First Aider’s Guide to Oxygen Therapy

As a registered nurse and first aid trainer, I’ve seen first-hand how oxygen can be a lifesaver in emergency situations. This blog is my way of sharing what I’ve learned over years of hands-on experience, aiming to provide fellow first aiders with a comprehensive yet practical guide to oxygen therapy.

This blog is part of a series focusing on the complexities of advanced resuscitation techniques that I teach in our HLTAID015 Provide Advanced Resuscitation and Oxygen Therapy Course at My First Aid Course Brisbane. These blogs aim to break down the components of the course, written in a user friendly fashion – the same way I deliver training. 

Oxygen Therapy is a lifesaving first aid technique. Throughout this article, we’ll explore what oxygen therapy is, why it’s crucial in emergency situations, and how to effectively administer it in the field. I’ll also share some real-life scenarios that illustrate the importance of this life-saving technique.

So buckle up. We’re about to take a deep dive into the world of oxygen therapy, and I promise you’ll come out better equipped to handle respiratory emergencies.

What is Oxygen Therapy?

At its core, oxygen therapy is exactly what it sounds like – the administration of oxygen as a medical intervention. But there’s more to it than simply giving someone ‘air to breathe’.

Oxygen therapy involves providing a patient with supplemental oxygen – that is, oxygen at concentrations higher than that of room air. While the air we breathe typically contains about 21% oxygen, therapeutic oxygen can range from 24% to 100%, depending on the patient’s needs and the delivery method used.

As first aiders, we primarily deal with two types of oxygen delivery systems:

1. Low-flow systems: These provide oxygen at lower concentrations and are typically used for patients who are breathing on their own but need a bit of extra support. Nasal cannulas and simple face masks fall into this category.
2. High-flow systems: These deliver higher concentrations of oxygen and are used in more severe cases. Non-rebreather masks and bag-valve-mask (BVM) devices are examples of high-flow systems.

The use of oxygen as a medical treatment has a fascinating history. While oxygen was discovered in the late 18th century (and fears were held that large amounts of oxygen might cause people to ‘live out too fast’, it wasn’t until the early 1900s that it began to be used therapeutically with continuous delivery systems.. During World War I, oxygen therapy saved the lives of many soldiers exposed to chemical warfare. Since then, it has become a cornerstone of emergency medicine.

In my years as a nurse, I’ve seen oxygen therapy evolve from bulky, stationary equipment to portable, user-friendly devices that we can easily carry to emergency scenes. This evolution has made our job as first responders much more effective, allowing us to start potentially life-saving treatment even before reaching the hospital.

Remember, as a first responder, you’re often the first link in the chain of survival. Understanding oxygen therapy isn’t just about knowing how to use the equipment – it’s about recognizing when a patient needs oxygen and how it can help them in those critical first moments of care.

Why is Oxygen Therapy Crucial for First Responders?

To understand why oxygen therapy is so vital in emergency response, we need to understand its role in the human body during crisis situations. Oxygen is quite literally the fuel that keeps our cells functioning. When the body is under stress – whether from injury, illness, or exertion – its demand for oxygen skyrockets.

As first aiders, we often encounter patients whose bodies are struggling to meet this increased oxygen demand. This is where our intervention becomes critical. By providing supplemental oxygen, we can help prevent or mitigate the devastating effects of hypoxia (low oxygen levels in the body), which can lead to organ failure and death if left untreated.

In my experience, there are several common emergency situations where oxygen therapy is crucial:

1. Respiratory Distress: Conditions like severe asthma attacks, chronic obstructive pulmonary disease (COPD) exacerbations, or pneumonia can severely impair a patient’s ability to breathe effectively. Oxygen therapy can provide immediate relief and help prevent further deterioration.
   
2. Cardiac Emergencies: During a heart attack or severe arrhythmia, the heart may struggle to pump oxygenated blood effectively. Providing supplemental oxygen can reduce the workload on the heart and improve oxygen delivery to vital organs.
   
3. Trauma: In cases of severe injury, especially those involving significant blood loss, oxygen therapy can help compensate for reduced oxygen-carrying capacity and support vital functions.

As first responders, we’re often working against the clock. Oxygen therapy is one of the most immediate and impactful interventions we can provide. It’s not just about treating symptoms – it’s about giving patients the best possible chance of recovery from the moment we arrive on scene.

How to Administer Oxygen Therapy in the Field

Before administering oxygen, we need to rapidly evaluate the patient’s condition. Look for signs of respiratory distress such as:

• Increased respiratory rate
• Use of accessory muscles: neck muscles ‘pulling in’ when a patient breathes
• Cyanosis (bluish discoloration of lips or fingertips)
• Altered mental status; dizzy, confused, agitated

Devices Commonly Used by First Responders:

1. Nasal Cannula: This is a low-flow device that delivers oxygen through two prongs inserted into the nostrils. It’s suitable for patients with mild respiratory distress and can deliver 24-44% oxygen at 1-6 litres per minute (LPM).
2. Simple Face Mask: This covers the nose and mouth and is used for patients requiring moderate oxygen concentrations. It can deliver 40-60% oxygen at 5-10 LPM.
3. Non-rebreather Mask: This high-flow system can deliver up to 95% oxygen at 10-15 LPM. It’s used for patients with severe respiratory distress or hypoxia.
4. Bag-Valve-Mask (BVM): This is used for patients who aren’t breathing adequately on their own. It can deliver nearly 100% oxygen and allows you to assist or control the patient’s ventilation.

Airway Adjuncts in Oxygen Therapy:

While discussing oxygen delivery devices, it’s important to mention the role of airway adjuncts in resuscitation and oxygen therapy. These tools can be crucial in maintaining a patient’s airway, which is essential for effective oxygen administration.

In a first aid situation, the only airway adjunct used is the oropharyngeal airway (OPA). This device helps prevent the tongue from obstructing the airway in an unconscious patient. 

Other adjuncts are available, but they are used by advanced emergency responders, such as paramedics.

These adjuncts don’t deliver oxygen themselves, but they can significantly improve the effectiveness of oxygen therapy by ensuring a clear airway. When using these devices, always follow your local protocols and training.

In my experience, being proficient with OPAs can make a substantial difference, especially when dealing with unconscious patients or those with compromised airways. Remember, a clear airway is the first step in effective oxygen delivery.

Determining Appropriate Oxygen Flow Rates:

The goal is to provide enough oxygen to maintain the patient’s oxygen saturation above 94% (or their baseline for COPD patients). Start with these general guidelines:

• Nasal cannula: 2-4 LPM
• Simple face mask: 6-10 LPM
• Non-rebreather mask: 10-15 LPM
• BVM: 15 LPM

Monitoring Patient Response:

Once oxygen is initiated, continuously monitor the patient’s:

• Respiratory rate and effort
• Oxygen saturation via pulse oximetry
• Level of consciousness
• Skin colour

Be prepared to adjust your treatment based on the patient’s response.

Potential Risks and Precautions:

While oxygen therapy is generally safe, there are a few precautions to keep in mind:

• In patients with COPD, high-flow oxygen can potentially suppress their respiratory drive. Monitor these patients closely. In an emergency situation we may not know anything about a patient’s medical history. In a first aid situation the rule of thumb regarding oxygen support is, it’s better to give oxygen, rather than withhold it due to uncertainty.
• Ensure oxygen sources are kept away from open flames or sparks, as oxygen supports combustion.
• Be aware of trip hazards from oxygen tubing and cylinders, especially in chaotic emergency scenes.

In my years of experience, I’ve learned that confidence with oxygen administration comes from practice. I encourage all advanced resuscitation first aiders to regularly practice with their oxygen equipment. The more familiar you are with your tools, the more effectively you can use them when seconds count.

Remember, oxygen therapy is a powerful tool, but it’s not a substitute for other necessary interventions. Always consider oxygen as part of your overall patient care strategy, not as a standalone treatment.

Best Practices for First Responders

Oxygen therapy is a crucial skill in the advanced resuscitation toolkit. To ensure we’re always ready to provide the best care possible, here are some best practices I’ve learned over the years:

Maintaining and Checking Oxygen Equipment:

Regular equipment checks are vital. At the start of each shift or before any standby duty:

• Check oxygen cylinder levels
• Ensure regulators are functioning correctly
• Inspect masks, tubing, and BVMs for damage or contamination
• Test the flow meter at various settings

Communication with 000/Emergency Services:

Clear communication can significantly improve patient outcomes:

• Inform 000 if you need additional oxygen resources
• Always mention if the patient is on oxygen, what type of delivery system you’re using, and at what flow rate
• Report any changes in the patient’s condition, especially their response to oxygen therapy

Documentation of Oxygen Administration:

Thorough documentation is crucial for both patient care and legal protection:

• Record initial oxygen saturation levels
• Note the type of oxygen delivery system used and flow rates
• Document any changes in therapy and the patient’s response
• Include times for all interventions

I always say, “If it’s not written down, it didn’t happen.” Good documentation can make a huge difference in the patient’s ongoing care.

Teamwork and Coordination in Oxygen Therapy Delivery:

In many scenarios, especially during CPR or when treating multiple patients, effective teamwork is essential:

• Clearly communicate who is responsible for managing oxygen therapy
• Practice scenarios where one team member manages the airway and oxygen while others perform other critical tasks
• Be prepared to swap roles if a team member becomes fatigued, especially during prolonged resuscitation efforts

Lastly, never stop learning. Oxygen therapy guidelines can change as new research emerges. Stay updated with the latest protocols and attend refresher courses regularly. Your knowledge and skills can make the difference between life and death.

Breathe Easy- You’ve got this

As we’ve explored throughout this blog, oxygen therapy is a cornerstone of emergency medical care. From my years as a registered nurse and first aid trainer, I can confidently say that mastering this skill is one of the most important things you can do as an advanced first aider.

We’ve covered what oxygen therapy is, why it’s crucial in emergency situations, how to administer it effectively, and best practices for its use in the field. But perhaps the most important takeaway is this: oxygen therapy, when applied promptly and correctly, saves lives.

But remember, oxygen therapy is not a magic bullet. It’s a powerful tool that works best when combined with your other skills, your ability to assess patients quickly and accurately, and your capacity to remain calm under pressure.

As first responders, we operate in a field that’s constantly evolving. New research, technologies, and protocols emerge regularly. That’s why I can’t stress enough the importance of continuous training and education. Attend workshops, participate in simulations, and stay updated with the latest guidelines. Your commitment to learning could make all the difference in a critical moment.

If you want to learn more and get some hands-on practice why not consider doing the HLTAID015 Provide Advanced Resuscitation and Oxygen Therapy Course at My First Aid Course Brisbane, I may just see you there!