We’re going to talk about one of the most crucial skills you’ll need as an EMS professional: knowing when to give oxygen and when to manage an airway with a BVM (bag-valve-mask). Understanding this will serve you throughout your entire career, so let’s dive in.

First, let’s clarify the difference between oxygenation and ventilation. When we talk about oxygenation, we’re simply providing oxygen to the patient. Ventilation, on the other hand, involves manually moving air in and out of the patient’s lungs.

Oxygen Devices

Nasal Cannula

This delivers 1 to 6 liters of oxygen per minute and is used for patients with mild symptoms. But when exactly do we give oxygen? The primary reason is when the patient’s SpO2 level is below 94%.

Non-rebreather Mask

This delivers 10 to 15 liters per minute and is for patients showing signs of respiratory distress. If a nasal cannula fails to raise the SpO2 above 94%, we switch to a non-rebreather.

Continuous Positive Airway Pressure (CPAP)

This amazing device pushes positive pressure into the lungs, helping to clear the alveoli. It’s used for conditions like heart failure, asthma, COPD, and pneumonia to improve gas exchange and clear fluid or infection.

However, CPAP is only for alert patients who can follow commands. If they’re too sick to obey commands, we move to airway management and ventilation.

Now, let’s talk about the signs and symptoms that indicate whether to give oxygen or manage the airway. Watch out for buzzwords like weak, sluggish, rapid, tired, and gasping. These indicate a very sick patient who needs either oxygen or ventilation. Here’s a mnemonic to help you remember this: RROWL. Let’s break that down!

RROWL Mnemonic

RROWL (Respiratory Rate, SpO2, Words per Sentence, Labored Signs)

  • Respiratory Rate: A normal rate is 12-20 breaths per minute. If it’s too low or too high, we might need to manage the airway.
  • SpO2: Below 94%, we need to give oxygen.
  • Words per Sentence: Can the patient speak in full sentences? If not, they might need oxygen or ventilation.
  • Labored Signs: Look for accessory muscle use, cyanosis, and poor skin condition (cool, clammy).

Here are some examples to illustrate:

Patient A: Sitting on a couch, speaking in full sentences, with a low SpO2 and normal respiratory rate – this patient needs a nasal cannula.

Patient B: Respiratory rate over 20, low SpO2, speaking one to two-word sentences, in a tripod position – this patient needs a non-rebreather mask.

  • If the non-rebreather fails: Switch to CPAP if the patient is alert.
  • Patient with a respiratory rate of 8, low SpO2, and not speaking or alert: This patient needs BVM and airway management.

Always visualize the scene and think about what you would do next. Remember this mnemonic and these signs for NREMT exams and real-life scenarios.

Remember, if a patient can speak and is alert, you’re not going to use a BVM. BVM is for those with severely low respiratory rates or who cannot manage their airway.

Use this information to decide your next steps and ensure you provide the best patient care possible.