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Oxygen

Category: Pharmacology Sources: raw/supplemental/emt-b-pharmacology.md, raw/supplemental/patient-assessment-sequence.md Last updated: 2026-04-03

Overview

Oxygen is the most commonly administered agent in prehospital care. Although not classified as a "drug" in everyday language, it is administered as a medication in EMS and treated with the same 6 Rights framework. It has no contraindications in the emergency setting — when in doubt, give oxygen.

Key Points

  • Indications: Hypoxia (SpO2 <94%), respiratory distress, chest pain (suspected ACS), shock, trauma, altered mental status, any patient who may benefit from supplemental O2.
  • Contraindications: None in the emergency setting. The concern about high-flow O2 suppressing hypoxic drive in COPD patients is real but does not apply in the acute emergency — treat hypoxia first.
  • Delivery devices and flow rates:
Device Flow Rate Approximate FiO2
Nasal cannula (NC) 1–6 LPM 24–44%
Non-rebreather mask (NRB) 10–15 LPM 60–90%
BVM (with O2) 15 LPM reservoir ~100%
Simple face mask 6–10 LPM 35–60%
  • Device selection: Match device to patient need. Mild hypoxia or low supplemental need → nasal cannula. Respiratory distress, chest pain, shock → non-rebreather. Inadequate breathing or apnea → BVM (see bvm-ventilation).
  • 6 Rights: Right patient, right drug, right dose, right route, right time, right documentation. Apply even to oxygen.
  • Reassess: After initiating O2, reassess SpO2 and patient comfort. Adjust device or flow rate based on response.

Assessment Relevance

Oxygen delivery decisions are made during primary-assessment (inadequate breathing → BVM; distress → NRB) and confirmed during secondary-assessment vital signs (SpO2 <94% → escalate). Trending SpO2 during reassessment verifies whether the chosen delivery method is adequate.

Target SpO2 in most patients: ≥94–98%. In COPD patients with known CO2 retention, target 88–92% to avoid over-oxygenation, but only adjust downward if SpO2 is confirmed above target and the patient is stable.

Procedures

See oxygen-administration for the full NREMT-tested skill procedure for nasal cannula and non-rebreather mask application.

General steps: 1. Select appropriate delivery device based on patient condition and SpO2. 2. Check cylinder pressure (minimum 200 psi for use; replace if lower). 3. Open cylinder valve; set flow rate. 4. Attach appropriate mask or cannula. 5. Apply to patient; confirm comfort and seal. 6. Reassess SpO2 after 1–2 minutes. 7. Document flow rate, device, and SpO2 response.

NM Protocol Notes

  • Oxygen is authorized at EMT-B level in NM without medical direction for any patient with hypoxia, respiratory distress, or suspected ACS.
  • NM EMS equipment standards require oxygen cylinders on all BLS units.
  • San Juan College EMT program follows NM EMS Bureau protocols — check current version for specific SpO2 thresholds.

NREMT Relevance

Oxygen administration is both a standalone skill station (oxygen-administration) and embedded in multiple other stations: - Patient assessment: appropriate O2 device selection is graded - BVM ventilation: O2 supplementation of the BVM is expected - Cardiac arrest: O2 setup is part of resuscitation management - Bleeding control/shock: O2 delivery is part of shock treatment

Common miss: selecting nasal cannula for a hypoxic, distressed patient (should be NRB). Know when to upgrade the delivery device.

Sources

  • raw/supplemental/emt-b-pharmacology.md — Oxygen section
  • raw/supplemental/patient-assessment-sequence.md — Breathing and Circulation sections