Oxygen

CPG Reference

Authorised Medications — Oxygen

Indications

✓ Oxygen should be titrated to achieve oxygen saturations of between 94–98% (or 88–92% for COPD patients)

Contraindications

✕ Explosive or flammable environments
✕ Normoxia

Precautions

⚠ If target saturations cannot be maintained with nasal cannula or medium concentration mask, change to a non-rebreather oxygen mask
⚠ Oxygen increases toxicity in paraquat poisoning — target saturations 88–92%
⚠ SpO2 readings may be affected by carbon monoxide poisoning and cold digits
⚠ Patients with acute episodes of COPD are at risk of developing carbon dioxide retention if given excessive supplemental oxygen — this can cause acidosis and subsequent organ dysfunction
⚠ High oxygen concentrations can lead to increased production of reactive free radicals resulting in cellular damage — may be detrimental in myocardial infarction and stroke
⚠ For patients with Asthma–COPD overlap, avoid uncontrolled oxygen therapy where possible — consider CSPSCC consultation

Dosing

Adult — Nasal Cannula

Amount 1–4 litres per minute

Route Inhaled — nasal cannula

FiO2 24–35%. Use for mild hypoxia or COPD patients requiring controlled low-dose supplemental oxygen

Adult — Simple (Therapy) Face Mask

Amount 5–8 litres per minute

Route Inhaled — simple face mask

FiO2 40–60%

Adult — Non-Rebreather Mask

Amount 10–15 litres per minute

Route Inhaled — non-rebreather mask

FiO2 60–100%. Ensure reservoir bag is fully inflated before applying to patient

Adult — Bag-Valve-Mask

Amount 15 litres per minute

Route Inhaled — bag-valve-mask

FiO2 100%. Used for airway management and ventilatory support

Paediatric

Amount As per adult flow rate ranges using appropriate mask size

Route Inhaled — appropriate mask

All paediatric patients with significant illness or injury should receive oxygen. Target SpO2 ≥95% for paediatrics. Newborn resuscitation should be commenced with room air for the first 30 seconds of initial inflation breaths

COPD Adult

Amount Titrate using nasal cannula or appropriate mask

Route Inhaled — nasal cannula or appropriate mask

Target SpO2 88–92% ONLY. Uncontrolled oxygen therapy in COPD leads to poor patient outcomes. Carefully titrate to avoid CO2 retention

Side Effects & Notes

Side Effects

• Cellular damage from reactive free radicals at high concentrations (potential detrimental effects in myocardial infarction and stroke)
• Carbon dioxide retention and acidosis in COPD patients if given in excess

Clinical Notes

→ Target saturations 94–98% for most patients; 88–92% for COPD patients or other conditions requiring controlled or low-dose supplemental oxygen
→ EHS volunteers are authorised to administer oxygen via nasal cannula, face mask, non-rebreather mask, and bag-valve-mask
→ Never cease oxygen administration if patient's level of consciousness or breathing deteriorates — oxygen almost never depresses breathing in the field
→ SpO2 readings may be falsely normal in carbon monoxide poisoning — do not rely on SpO2 alone in suspected CO exposure
→ Oxygen IS the antidote for carbon monoxide poisoning — administer at 100% FiO2 via non-rebreather mask
→ For diving emergencies (decompression illness), administer high-flow oxygen at 100% FiO2 at 10–15 litres per minute
→ For asthma: titrate SpO2 to 92–95% adults, ≥95% paediatrics; ventilate at no more than 4–6 breaths per minute to allow adequate exhalation and avoid air trapping
→ Remove mask from patient's face BEFORE turning off the oxygen supply
→ SJWA officers treating patients on home BiPAP/CPAP or with tracheostomy who present with infective respiratory illness must wear full PPE for aerosol generating procedures

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