Oxygen Administration

Category: Procedures Sources: raw/nremt/psychomotor-skills.md, raw/supplemental/emt-b-pharmacology.md Last updated: 2026-04-03

Overview

Oxygen administration is the procedural skill for delivering supplemental oxygen via nasal cannula or non-rebreather mask. It is one of the most frequently performed EMT-B skills and is a standalone NREMT psychomotor station. Device selection is the key clinical decision — match the delivery device to the patient's oxygen need and condition. See oxygen for full pharmacology reference.

Key Points

• Device selection criteria:
• Nasal cannula (NC): mild hypoxia, low supplemental O2 need, patient who cannot tolerate a mask (claustrophobia, facial anatomy), conscious patient requiring ongoing talking/eating
• Non-rebreather mask (NRB): respiratory distress, SpO2 <94%, chest pain, shock, significant trauma, any patient requiring high-concentration O2
• BVM: absent or inadequate breathing — see bvm-ventilation
• Flow rates:
• NC: 1–6 LPM (delivers approximately 24–44% FiO2)
• NRB: 10–15 LPM (delivers approximately 60–90% FiO2); must flow enough to keep reservoir bag inflated
• Cylinder pressure: Check gauge before use. Minimum usable pressure: 200 psi. Replace or switch cylinders before reaching empty.
• Equipment: Oxygen cylinder, regulator/flowmeter, appropriate delivery device (mask or cannula), oxygen tubing.

Assessment Relevance

O2 device selection is driven by findings from primary-assessment (breathing status, distress level) and secondary-assessment (SpO2 measurement). Decision tree: - Breathing + SpO2 ≥94% + no distress → may not need supplemental O2 (monitor) - Breathing + SpO2 <94% or respiratory distress → NRB at 10–15 LPM - Breathing + mild supplemental need → NC at 2–4 LPM - Not breathing / inadequate breathing → BVM with O2 (see bvm-ventilation)

After initiating O2, trend SpO2 during reassessment. If SpO2 does not improve on NC, upgrade to NRB. If NRB is not sufficient, escalate to BVM-assisted ventilation.

Procedures

Nasal Cannula Application

1. Don BSI/PPE.
2. Select nasal cannula and connect to flowmeter tubing.
3. Open O2 cylinder; set flow to ordered rate (1–6 LPM).
4. Place prongs in patient's nostrils, curved side down.
5. Route tubing over ears and tighten slip ring under chin.
6. Confirm comfort and prong position.
7. Reassess SpO2 after 1–2 minutes.
8. Document: device, flow rate, baseline SpO2, post-O2 SpO2.

Non-Rebreather Mask Application

1. Don BSI/PPE.
2. Select NRB mask appropriate for patient size (adult/pediatric).
3. Connect mask to O2 tubing; set flow to 10–15 LPM.
4. Pre-inflate reservoir bag before placing on patient — occlude one-way valve with finger and allow bag to fill completely.
5. Place mask on patient face; mold metal nose strip for seal.
6. Adjust elastic strap for secure but comfortable fit.
7. Confirm reservoir bag deflates slightly with each inhalation — this indicates proper function.
8. Reassess SpO2; adjust flow if needed to maintain inflated reservoir.
9. Document: device, flow rate, SpO2 response, time.

Cylinder Management

• Open cylinder valve fully (counterclockwise) then back one-quarter turn.
• Check pressure gauge: green zone = adequate; below 200 psi = low, prepare to switch.
• Close valve when finished; bleed the line.
• Mark used cylinders.

NM Protocol Notes

• NM EMT-B protocols authorize oxygen administration without online medical direction for indicated patients.
• All BLS ambulances in NM are required to carry O2 cylinders and both NC and NRB delivery devices.
• NRB is the standard choice for: chest pain (ACS protocol), respiratory distress, anaphylaxis (co-administered with epinephrine-auto-injector), shock, significant trauma.
• Target SpO2: ≥94% for most patients. In COPD with known chronic hypoxia, target 88–92%.

NREMT Relevance

Oxygen administration is a standalone NREMT psychomotor skill station. Examiners test: - Correct device selection for the given scenario - Pre-inflating NRB reservoir before placement - Correct flow rate for the selected device - Proper mask application and seal - Patient reassessment after O2 initiated

Common failures: - Applying NRB at 4 LPM (too low — reservoir won't stay inflated) - Not pre-inflating the NRB reservoir bag - Using NC when the patient needs NRB (low-flow O2 for a hypoxic patient) - Not reassessing after applying O2

Related

• oxygen — pharmacology reference for O2 indications, contraindications, and dosing
• bvm-ventilation — escalation from NRB when breathing is absent or inadequate
• primary-assessment — breathing status and distress level drive initial device selection
• secondary-assessment — SpO2 obtained here confirms O2 need
• reassessment — trending SpO2 response to O2 therapy
• aspirin — O2 co-administered with aspirin in ACS management
• epinephrine-auto-injector — O2 co-administered in anaphylaxis management
• bleeding-control-shock — O2 is part of shock management

Sources

• raw/nremt/psychomotor-skills.md — Oxygen Administration
• raw/supplemental/emt-b-pharmacology.md — Oxygen section