FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Supplemental oxygen or ventilatory support under the relevant BLS/ALS condition-specific pathway.
Contraindications & local exclusions
- I-15 does not establish a universal absolute contraindication list. Oxygen saturation targets and delivery methods are condition-specific; no unsupported general exclusion is added here.
Precautions
- Follow the applicable oxygenation/ventilation targets and reassess response. Device settings, pulse oximetry and the clinical condition matter; the listed ALS guide does not remove authorized BLS oxygen use. The reference Airgas medical oxygen USP cylinder label identifies an oxidizer/fire hazard: keep oil and grease away from valves/fittings, prohibit smoking and ignition sources, secure/store in a ventilated area, and open the valve slowly. These handling warnings do not provide a complete clinical contraindication or oxygen-target comparison.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- A normal or high pulse-oximeter reading may be misleading with smoke/carbon-monoxide exposure.
- Do not mistake oxygen delivery for correction of apnea or inadequate ventilation.
Use in OCEMS
- Used for hypoxia and in selected smoke/CO exposure, resuscitation, and diving-related pathways.
- SpO₂ alone cannot assess ventilation; use respiratory effort and available capnography alongside oximetry.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| General I-15 oxygen therapy | High-flow mask (preferred; I-15 lists 10 L/min) or nasal cannula at 6 L/min, as tolerated, for suspected hypoxia/SpO₂ below 95% and specified exposure indications. |
| COPD respiratory distress — SO-M-035 | The initial NC option is 2 L/min. Do not withhold oxygen in severe hypoxia/distress; prepare to assist ventilation. |
| Chronic home oxygen | I-15 lists maintenance of the home flow rate; acute distress still requires assessment and treatment under its standing order. |
Pediatric
- Pediatric respiratory orders use high-flow mask or nasal cannula/direct blow-by at 6 L/min as tolerated when SpO₂ is below 95%.
- Support inadequate ventilation with BVM as indicated. The adult COPD-specific 2 L/min wording is not a pediatric default.
Pediatric dose by age / weight
- SO-P-035 uses oxygen according to respiratory status and oxygen saturation, not an mg/kg formula. Assist inadequate ventilation with BVM.
| Weight | Treatment trigger | Delivery |
|---|---|---|
| Any pediatric weight | Room-air SpO₂ below 95% under the respiratory order | High-flow mask or nasal cannula/direct blow-by at 6 L/min, as tolerated |
Preparation & reassessment
- Select the device and flow specified for the condition and reassess tolerance, work of breathing, oxygenation, and ventilation.
- For cardiac arrest, use the resuscitation airway/ventilation pathway. For CPAP, check age, contraindications, pressure, and monitoring separately.
UNDERSTAND THE CARE
Why oxygen delivery does not prove effective breathing
Oxygen supplementation and movement of air are different treatment concerns. Combine pulse oximetry with respiratory effort, air movement, consciousness and available capnography. The local guide specifically warns that smoke or carbon-monoxide exposure can produce a misleadingly reassuring pulse-oximeter value.
Applying the guidance
Use the device, flow and targets from the relevant clinical order and reassess the patient’s tolerance and response. The adult COPD starting instruction is not a universal pediatric setting. Arrest and CPAP pathways carry their own ventilation, device and monitoring requirements. Also follow the medical-oxygen handling and fire-safety information linked in the guide.
Diagram text & teaching checkpoints
- Oxygenation
- Interpret SpO₂ in the exposure context.
- Ventilation
- Assess effort, air movement and available capnography.
- Delivery
- Match condition, device and prescribed flow.
- Response
- Reassess clinical breathing and oxygenation.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- SO-M-035 — Respiratory Distress
- SO-P-035 — Acute Respiratory Distress - Pediatric
- SO-E-005 — Burn (Thermal, Electrical, Chemical) - Adult
- SO-P-040 — Cardiopulmonary Arrest - Pediatric
- Reference cylinder label — Airgas compressed medical oxygen USP — handling label
Explain a reassuring number in its clinical context
A displayed saturation is one finding, not the entire respiratory assessment. Note how it was obtained, the patient’s effort and air movement, and whether oxygen or assisted ventilation was already in use. Keep the condition-specific delivery instructions rather than substituting one universal flow or target for every presentation.
For example, several people from the same enclosed environment have headache and nausea while the pulse oximeter appears reassuring. The exposure history remains important. CDC states that conventional two-wavelength pulse oximetry is inaccurate in the presence of carboxyhemoglobin; that number cannot rule out carbon monoxide poisoning.
Report the time removed from the environment, symptoms, oxygen device and flow, treatment start time and subsequent findings. Continue the applicable OCEMS exposure and respiratory pathway. An oxygen cylinder, mask or improving saturation does not establish adequate ventilation; reassess the patient’s actual breathing and provide the airway support required by the clinical situation.
Source: Adult / Adolescent Standing Order Drug Guide.
Exposure context: CDC clinical guidance for carbon monoxide poisoning.