How-to | Administering oxygen onboard

Indications for Administering Medical Oxygen (onboard)

Hypoxemia: When blood oxygen levels are lower than normal.
Respiratory Distress: When a patient is having difficulty breathing.
Cardiac Arrest: To support oxygenation during resuscitation efforts.
Severe Trauma: To ensure adequate oxygenation of tissues.
Shock: To maintain oxygen delivery to vital organs.
Carbon Monoxide Poisoning: To displace carbon monoxide from hemoglobin.
Acute Asthma: During severe asthma attacks to alleviate hypoxemia.
Pulmonary Edema: To improve oxygenation in cases of fluid accumulation in the lungs.

How do we provide Oxygen

Step 1 - Choose your mask

Simple Face Mask

Delivers 40-60% oxygen
Set flow rate: 6-10 L/min
Covers the nose and mouth

Non-rebreather Mask

Delivers 85-90% oxygen
Set flow rate: 15 L/min
Includes a reservoir bag and one-way valves to prevent rebreathing of exhaled air

Bag-Valve Mask (BVM)

Used for manual ventilation, usually when you perform CPR, for the 2 rescue breaths every 30 chest compressions
Set flow rate: 15 L/min
Can deliver nearly 100% oxygen when connected to an oxygen source
Consists of a self-inflating bag, a one-way valve, and a mask that covers the nose and mouth
Do not keep patients on 15L for longer than necessary as over-oxygenating for prolonged periods can be harmful.

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Pro Tip If you turn the adult BVM face mask upside down (triangle facing the chin), it can be placed on a child. No air must escape, as we are not medical professionals have a second person hold the mask with two hands, pulling the chin upwards when giving air.

Step 2 - Connect your cylinder

Check your cylinder Ensure the cylinder does not have any cracks on its body. Check that the oxygen has been replaced within the last 3 years and that the cylinder has been hydrotested in the last 5 years.
Attach the Regulator: Connect the regulator to the oxygen cylinder. It will most likely have a yoke type regulator. Don’t forget the black “yoke washer”. If you hear a leaking noise after you place the regulator it either it doesn’t have a washer or the regulator is leaking.
Check cylinder pressure: Set regulator flow to 0 and open the valve, it will show the cylinder pressure which should be in the green section.
Connect the hose, From the the regulator to the mask.
Set the Flow Rate: Adjust the regulator to the desired flow rate, as specified for the mask type.
Check for Oxygen Flow: Ensure oxygen is flowing through the tubing and out of the mask before placing it on the patient. Fill up the oxygen bag prior to administrating oxygen.
Apply the Mask to the Patient: Place the mask over the patient's nose and mouth, ensuring a snug fit.

Step 3 - Airway Management

You have to ensure the airway is open before administering oxygen. For example, an unconscious patient might have a closed airway due to the tongue falling backward.

For more information on managing an open airway onboard, see

How-to | Airway Management onboard

Step 4 - What can go wrong

The success of the intervention can be seen as the patient's oxygen levels rise. If they are still decreasing, something is wrong. Note that saturations should be maintained at 94-98%, not 100%. Monitor this with the oximeter placed on the patient's finger.

If the BVM (bag-valve-mask) becomes hard to press while resuscitating a patient, it might mean they have started to breathe again, even if still unconscious. If this happens, stop oxygen administration and ensure their oxygen saturation remains stable above 94%. If you don't stop, the patient might develop gastric distension (i.e., start vomiting even if unconscious) as the pressure in the stomach becomes higher than the pressure outside.