Page 110 - 2023 SMOG Digital

MEDICATION, DRUG CARDS
a. General Use
i. Use as clinically indicated per guideline.
b. Medications, all:
ii. If carried, these medications are available for use, within the limitations of these
guidelines, drug cards, and supervising medical director/physician. These
medications may be used during transfer of critical care patients or during point
of injury. These medications are available for use on any patient, within the
limitations of these guidelines, as clinically indicated, to address acute life-
threatening emergencies not accounted for on the transferring physician’s
written orders. Some medications utilized during critical care transfer requires
written orders and guidance from transferring physician or as directed by unit
medical director/supervising physician.
Oxygen
Class: Atmospheric gas.
Mechanism of Action: The essential substrate for cellular respiration.
Duration of action: Onset: immediate. Peak effect: not applicable. Duration: less than 2 minutes.
Indications: All causes of decreased tissue oxygenation and/or decreased level of consciousness.
(Confirmed or expected hypoxemia, ischemic chest pain, respiratory, insufficiency, prophylactically
during air transport, confirmed or suspected carbon monoxide poisoning). Also provides mechanical
work for gas-powered ventilators, if supply and flow rate is sufficient (OBOGS will not work).
Contraindications: Coincidental paraquat inhalation (rare); COPD patients may become hypopneic with
high O 2 flow rates due to “oxygen baroreceptor respiratory drive (relative contraindication).
Adverse Reactions: Retinopathy of prematurity (prolonged use); potential oxygen toxicity in hyperbaric
environments; cerebral vasoconstriction.
Drug Interactions: None
How Supplied: Medical grade Oxygen is 93% O2 (+/- 3%) under United States Pharmacopeia (USP)
Standards. USP Standard O2 is supplied through compressed gas cylinders (D cylinder) or continuous
flow oxygen generator or concentrator systems.
Dosage and Administration:
• Assure adequate ventilation (spontaneous or supported) coincidental to supplemental oxygen
therapy, ideally by end-tidal CO2 measurement (Goal EtCO 2 35-45).
• All critically ill and injured transport patients will receive supplemental oxygen to maintain SpO2 of >
93%.
• Administer oxygen 2-6 LPM via nasal cannula.
o If O 2 Saturation remains < 95%, apply non-rebreather face mask with oxygen at 15 LPM.
o If O 2 Saturation remains < 90%, refer to Airway guideline.
• Patient on Ventilator:
o Adjust ventilator settings based on ventilatory goals for patient: EtCO 2 , peak pressures,
SpO 2 , and patient clinical condition.
o Adjust FiO 2 to maintain pulse oxygen saturations > 93%/tissue oxygen saturation
(StO2) > 70%, if applicable.
• When planning for available O2 during non-pressurized, aeromedical transfer, ensure adequate
resources to provide 1.5 to 2 times the ground transport volume of O2 to compensate for increased
consumption associated with altitude related physiological impact.

110