15 Oxygen is probably the most common drug to be used in the care of patients who present with medical emergencies.1 Hypoxaemia (low level of oxygen in arterial blood), needs to be corrected when identified, as there is good evidence that severe hypoxaemia is harmful, adversely affecting patient outcome. Patients who are breathless, or exhibiting signs of respiratory distress, should be assessed for hypoxaemia as soon as possible using pulse oximetry (SpO2). Oxygen saturation, considered the fifth vital sign, is recorded at least 12 hourly in all patients in the acute care setting. Target saturations are set by medical staff2 and should be maintained at all times (Figure 15.1) with immediate action required to restore values to within normal, or near normal, range with prescribed supplemental oxygen. Currently there is no evidence of benefit in giving supplemental oxygen to patients who are not hypoxaemic even if they are ‘out of breath’ (Table 15.1). This group may be at risk of harm from inappropriate supplemental oxygen so caution is required.2 Hypoxaemic patients benefit from being in an upright position, supported by pillows, maximising FRC (see Chapter 12 & Figure 12.5), thus increasing the surface area available for gaseous exchange to occur. The pressure of the abdomen on the diaphragm is decreased, helping to increase chest expansion and lung volumes. The British Thoracic Society have published guidelines,2 for oxygen use in adult patients, that are widely endorsed and adopted.
Oxygen therapy
Positioning
Oxygen therapy
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