Oxygen supply refers to an oxygen cylinder or wall unit that connects to an administration device to deliver oxygen to the patient.

When the patient is receiving oxygen from one of these systems, be sure to check the following equipment !"alve handles to open the cylinder, pressure gauge, and flow meter !#ubing connecting the oxygen supply to the patient$s oxygen administration device %asal &annula #he nasal cannula '(igure )* is a low+flow oxygen administration system designed to add oxygen to room air when the patient inspires. !, nasal cannula provides up to --. oxygen. !/n this low+flow system, inspired air mixes with room air. #he ultimate inspired oxygen concentration is determined by the oxygen flow rate through the cannula and how deeply the patient breathes 'tidal volume*. !/ncreasing the oxygen flow by ) 01min 'starting with ) 01min* will increase the inspired oxygen concentration by approximately -. 2 ) 01min 3). to 3-. 2 3 01min 34. to 35. 2 6 01min 37. to 63. 2 - 01min 66. to 68. 2 4 01min 69. to -:. 2 8 01min -). to --. (ace ;ask , simple face mask delivers low oxygen flow to the patient$s nose and mouth. , partial rebreathing mask consists of a face mask with an attached reservoir bag '(igure 3.* , face mask can supply up to 8:. oxygen with flow rates of 8 to ): 01min '#able )*. , face mask with oxygen reservoir 'nonrebreathing mask* provides up to 7:. to )::. oxygen with flow rates of 7 to )4 01min. /n this system a constant flow of oxygen enters an attached reservoir. <se a face mask with a reservoir for patients who !,re seriously ill, responsive, and have adequate ventilation but require high oxygen concentrations !;ay avoid endotracheal intubation if acute interventions produce a rapid clinical effect 'eg, patients with acute pulmonary edema, chronic obstructive pulmonary disease =&O>?@, or severe asthma* !Aave relative indications for endotracheal intubation but maintain an intact gag reflex !Aave relative indications for intubation but have clenched teeth or other physical barriers to immediate intubation #he above patients may have a diminished level of consciousness and may be at risk for nausea and vomiting. , tight+fitting mask always requires close monitoring. Buctioning devices should be immediately available. "enturi ;ask , "enturi mask enables a more reliable and controlled delivery of oxygen concentrations from 3-. to 4:.. <se the "enturi mask for patients who retain carbon dioxide '&O3*.>atients who have chronic high levels of &O3 in their blood and moderate+to+severe hypoxemia may develop respiratory depression if the drive stimulating them to breathe 'oxygen* is reduced. !, "enturi mask can accurately control the inspired oxygen concentration. <se this mask in patients with &O>?, who usually have chronic hypercarbia 'high &O3* and mild to moderate hypoxemia. !,dministration of high oxygen concentrations to patients with end+stage &O>? may produce respiratory depression because the increase in >aO3 eliminates the stimulant effect of hypoxemia on the respiratory centers. !%ever withhold oxygen from patients who have respiratory distress and severe hypoxemia simply because you suspect a hypoxic ventilatory drive. /f oxygen administration depresses ventilation, support ventilation. ?elivered oxygen concentrations can be adCusted to 3-., 35., 64., and -:. using a flow rate of -+ 5 01min and -:. to 4:. using a flow rate of ):+)3 01min. Observe the patient closely for respiratory depression. <se a pulse oximeter to quickly titrate to the preferred level ofoxygen administration

Dag+;ask "entilation Overview #he bag+mask device, which typically consists of a self+inflating bag and a nonrebreathing valve, may be used with a face mask or an advanced airway '(igure 6*. Dag+mask ventilation is a challenging skill that requires considerable practice for competency. >roviders can provide bag+mask ventilation with room air or oxygen if they use a self+inflating bag. #his device provides positive+pressure ventilati on when used without an advanced airway and therefore may produce gastric inflation and its complications <se With an ,dvanced ,irway ,dvanced airway devices such as the laryngeal mask airway '0;,* and esophageal+tracheal &ombitube are currently within the scope of E;B providers in several regions 'with specific authoriFation from medical control*. #hese devices are acceptable alternatives to bag+mask devices when used by healthcare providers who are well trained and have sufficient experience to use them. /t is not clear that these devices are any more or less complicated to use than a pocket maskG training is needed for safe and effective use of both a bag+mask device and each of the advanced airways. #ips for >erforming Dag+;ask "entilation !/nsert an oropharyngeal airway 'O>,* as soon as possible if the patient has no cough or gag reflex to help maintain the airway. !#here is no specific tidal volume recommended for adults. /nstead the tidal volume should be sufficient to achieve visible chest rise. !;any healthcare providers cannot create a leakproof seal between the mask and face using ) hand. #he hand holding the mask must perform 3 tasks simultaneously perform a head tilt and press the mask against the face while lifting the Caw. >erform and maintain a head tilt, and then use the thumb and index finger to make a &, pressing the edges of the mask to the face. %ext use the remaining fingers to lift the angle of the Caw and open the airway '(igure -,*. !(or these reasons many experts recommend that 3 well+trained, experienced healthcare providers work together during bag+mask ventilation. One provider should hold the mask with 3 hands, creating a leakproof seal between the mask and the face while lifting the patient$s Caw. #he second provider squeeFes the bag slowly and gently over ) second per ventilation '(igure -D*. !#hese seal and volume problems do not occur when the bag+mask device is attached to the end of an advanced airway device 'eg, endotracheal tube =E##@, &ombitube, or 0;,*. Overview #he &ombitube '(igure 4* is an advanced airway that is an acceptable alternative to the use of an E##. #he &ombitube is an invasive airway device with 3 inflatable balloon cuffs. /t is inserted without visualiFation of the vocal cords. #he tube is more likely to enter the esophagus than the trachea. When the tube does enter the esophagus, ventilation occurs through side openings adCacent to the vocal cords and trachea. /f the tube enters the trachea, ventilation can still occur by an opening in the end of the tube. Btudies show that healthcare providers with all levels of experience can insert the &ombitube and deliver ventilation comparable to that achieved with endotracheal intubation. #he advantages of the &ombitube are chiefly those related to ease of training. Dut only providers trained and experienced with the use of the &ombitube should insert the device because fatal complications are possible. Overview #he 0;, '(igure 9* is an advanced airway device that is considered an acceptable alternative to the E##. #he 0;, is composed of a tube with a cuffed mask+like proCection at the end of the tube.

Overview >lacement of an endotracheal tube 'E##*, or endotracheal intubation, provides advanced airway management. #he E## !Heeps the airway patent !Enables delivery of a high concentration of oxygen !facilitates delivery of a selected tidal volume to maintain adequate lung inflation !;ay protect the airway from aspiration of stomach contents or other substances in the mouth, throat, or upper airway !>ermits effective suctioning of the trachea !>rovides an alternative route for administration of resuscitation medications when intravenous '/"* or intraosseous '/O* access cannot be obtained. #hese medications are atropine, vasopressin, epinephrine, and lidocaine.. %ote however that drug delivery and drug effects following endotracheal administration are less predictable than those delivered by the /"1/O route. #he &ombitube and 0;, are now considered acceptable alternatives to the E## for advanced airway management. ;isplacement of an E## can result in severe, even fatal, complications. (or this reason only skilled, experienced personnel should perform endotracheal intubation. /n most states medical practice acts specify the level of personnel allowed to perform this procedure. (or clinical reasons intubation should be restricted to healthcare providers who meet the following criteria !>ersonnel are well trained. !>ersonnel perform intubation frequently. !>ersonnel receive frequent refresher training in this skill. !E## placement is included in the scope of practice defined by governmental regulations. and !>ersonnel participate in a process of continuous quality improvement to detect frequency of complications and minimiFe those complications. >lacement of an E## is an important part of a resuscitation attempt. Dut it is a much lower priority than providing high+quality continuous chest compressions with few interruptions, delivering defibrillation as needed and establishing /"1/O access.