Transcript
Retired from teaching.
Lainie actually took my position, and as the head athletic trainer, it does down school as well as teaching the EMT class, which I was able to teach for 3 years at at Dosedown High School with a 21 year career at that high school, 24 total in a secondary school.
And 15 years and collegiate at Stensted, Mississippi State, University of Alabama, and then the program director of Anthony Training Education at Southeastern Golan's where we were able to become a k HEPA credit it program.
My passion though really has been in a secondary school setting.
I had an incredible career and wouldn't change it for anything in the world.
My passionate and emergency medicine dates back to 1983, where I was able to take an EMT client.
It's got licensed when it lapsed.
And then then started the process back over about 4 years ago and love, love, love, the connection between the EMS profession and the athletic training profession so much that I joined Doctor Castle, and now our passion is to bridge the gap between these 2 professions as well as educate athletic trainers on current practices and best practices.
So I am co founder and CEO of my sports dietitian, which is a a co partner.
I am my co owner of Action Medical Consultants.
No endorsement of any brand or equipment display that you might see.
We have no endorsement there.
And also refer to your state law and a t scope of practice when implementing any knowledge and skills and the images that you'll see are from open sourcing come from the pre the emergency care 11th edition.
Alright.
So this is what we're gonna cover.
We're gonna describe the oxygen therapy basics and clinical uses We will take a look at when to use it, when not to use it.
We will take a look at its vital role in in the care what it does and what it does not, as well as identify the equipment that's needed to pull us off.
We'll demonstrate the setup how to get it up and going.
And then we will explore the the variety of methods.
We have 4 methods to distribute this oxygen.
So When do we use it?
When does it get get used?
So first of all, you only use it if you've been trained to use it.
Right?
You're you're authorized to do it.
Meaning, you have a medical direction.
You have a scope of practice.
It is written down.
It is practiced.
It is equipment is checked off.
Right?
Also, you do not delay basic life support.
In order to get the equipment.
Oxygen is vital.
Oxygen is important, but there are other things like the AED.
That will trump the supplemental oxygen capacity.
So you gotta make sure, like, a open airway like we just discussed, keeping it maintaining an open airway.
Trump's the delivery of oxygen.
You always have to make sure it's clean and operational It's nothing more embarrassing than getting your oxygen tank out, and it'd be empty, and you are all set up and ready to go.
And so you have to make sure just like checking your battery.
It's just like checking your a d that you're always checking that you have.
The proper amount of oxygen to use if you're actually going to orient with you and put it in your scope.
You gotta Figure out what equipment is used for which needs.
There's different tools in the toolbox, so you gotta be able to distinguish between the two.
Once you begin the intervention, then you gotta monitor.
It's not like just put it on and leave it.
You have to watch and see the response that you get from this auction, you know, this thing runs out and you have to go get a refill And so you gotta go to the proper vendor to get it refilled and replaced and tested.
I know one time I sent my cylinder off to be refilled, and they said, oh, it doesn't pass inspection, and you gotta get another one.
And that's the quality check that is in place when you go to a quality facility to make sure that they protect you.
And so we got a new cylinder and we kept moving on.
Now I just exchanged, like, a rental.
I don't even keep the same cylinder.
I just exchanged cylinders.
When I was at Dutch Town High School, also just practice and maintain skills.
So these are the kinds of overarching things you have to remember when you are implementing oxygen to your patient.
So next next thing, who who is this for?
And so you when you take a look at the shortlist and this is a short list of athletes that have these kinds of medical conditions who would qualify for ox in.
Now when we break this down into practical terms, you know, we're we're looking at who qualifies as everybody get question.
And the answer is no.
You have to qualify.
And that's what a protocol does is it sets up the framework of what qualifies a patient to give and so anybody that has respiratory distress like Doctor.
Hoffman mentioned below 8, above 28 is is a common framework that I have used over the years, they would qualify for oxygen.
Any kind of abnormal lung sounds an SPO 2 reading below 94 and any kind of scanned disc color typically pale or blue would all qualify, and it only takes really one to tell you that your patient is decompensating.
Just one of those for would give you a clue that the patient is decompensating, which basically means that they are in they are in Austrian debt, and they are beginning you have cellular death and the whole cascade of shock is beginning to accelerate and therefore we need to fill the gap.
So before we get started, we gotta recognize the dangers of oxygen.
And number 1 is a pressurized cylinder.
That's why it has to be in a padded bag in the last presentation with Lainie.
We talked about where you store it, that bag she was referring to as a padded bag.
It's not like a regular kid.
It's soft in the bottom.
It has a strap that holds the cylinder in place.
So you gotta put it in the right kind of bag You have to understand that there is a combustible effect to it and that it does react to petroleum products.
Can't put any mask and tape or any kind of glue or tape that has a petroleum based product on your cylinders.
It's called like a football helmet.
You can't add anything else to it.
You do not you do not use it in a means that is contradictory to.
What is intended for.
And then there is a danger in long term use.
These are more people with chronic lung disease where auction can be used over a long period of time, which really doesn't play into the athletic setting, but it is there as a means to recognize the dangers of oxygen in some capacity.
So when we take a look at the equipment, basically, we have a regulator that's at the top, we have a cylinder that come in various sizes, and then we have the applicator.
What's not in this sign is a bag valve mass and a pocket mass.
So We gotta add those 2 as well as the other options of auction and delivery, but this is what you're looking for in an auction kit.
Now it could come in different size.
The size d was the most common size that I would use.
That would give us about 30 minutes of full flow oxygen to give you a reference.
In EMS, you're going to find more of the e and jumbo d.
Being used that will give you longer longer use of oxygen.
So the Regulator is our friend.
Our friend meaning it's there to protect us, and it reduces the amount of pressure that comes from the cylinders so it can be distributed in a in a more user friendly fashion.
And as you see on the picture on the lab, it has a pin index safety system, which basically locks it in place and doesn't allow it to slip up and down once it's been secured onto the cylinders.
So you have to align those pins in order to begin to attach the regulator.
You didn't really don't want the regulator on there if it's not.
Ready to be used is not something that you want to have permanently attached to the to the cylinder because you will find even like this one who has the key already attached, which now they do not have the key which is a top part where you actually turn it on and move it from the from the cylinder up to the regulator, but calls it think it's bumped, and all of a sudden, you'll look up you'll have a slow week of oxygen.
And so this is a protection means as well as a means to secure the oxygen and keep it from leaking out.
So when it comes to you, it's gonna look similar to this.
It has been tested It has been wrapped, it has been secured, and now it's ready for use.
And so you would check the label for auction.
And and that is what we're looking for when we get it back from our vendor that is filling it up.
So we place the cylinder upright position and stand to one side, and then we're going to begin to take the seal off.
And then we're going to crack the main valve for one second.
It will blow off the oxygen, any dust, any dirt.
That is accumulated, and we will ensure that all is working and that we're getting oxygen from the cylinder out to our into the environment so that we're ready for use.
Now we're ready to hook up the regulator.
So you see those pins.
They're showing the two holes in the pins.
And goal number 1 is to get those pins in those two holes.
And sometimes you have to slide it up and down until you feel that notch, and everything has to align.
And therefore, you know now that once you feel them go into They're positioning now, you can begin to tighten down and secure the regulator.
So here we are the 2 pins and the 2 notches, but you also have to make sure that the gasket you see in his left hand and his finger is in place, or you will be able to leak and you'll get a constant flow of oxygen coming out.
And so you gotta make sure you have that little gasket in place as well.
So here we go.
Now we put the pins in place.
We secured the oxygen.
And in his right hand, he is now attaching the regulator to the to the cylinder, you have to make sure it's in an off position as you begin to if you don't, you're gonna start getting oxygen coming out.
Immediately, so you gotta make sure it's off and then get it secured.
So once you do this at time or 2, it's pretty simple, pretty easy.
There seems like there's a lot of steps and and somewhat there are, but you'll find that that it will go on quite easy once you get going.
So we tie We screw this down, and you can see now in this particular regulator, they don't have a key attached, which is what I highly recommend.
And you can see in a second, he will have a key on this little key chain that then you will use, and that is for safety purposes, but also This is hard to turn.
This is hard to move.
So after you get the pins aligned, you attach the regulator, Now you're ready.
You can see here the gasket's in place.
The pins are aligned.
You're looking straight up and down.
There's no key attached, and you have it on.
And you're ready to now begin to decide what device do you want to hook up to this.
So we now We'll test this where we open up the top part and this moves oxygen from the cylinder up to the regulator.
In the right hand, That is like safety valve number 1.
It moves it from the cylinder up to the regulator and allows it to be distributed.
And you can see over here the 0 The 0 indicates nothing is coming out.
We don't want anything coming out yet.
Plus, you see all the dial there.
It tells you how much oxygen you have left, and and that gives you a clue as to how much time you have.
And this is a check stub that you would do on a consistent basis before you would actually go out to the event to make sure that the tank is actually filled.
And then It is ready for use.
You hook up the nipple to the to the regulator, and it's ready for application.
Now When we get ready, you can see on the dial.
We have we have a variety of numbers that we can turn it to, and these are measured in liters per minute.
And so this one is set at 12 right now, which is which is sort of a medium flow.
Most of them go to about 25 in their full flow capacity even though we really won't need that much, we will begin to find ourselves somewhere hovering anywhere from 1 to 15 liters per minute.
So as we talk about some of the application devices, the non re breather is probably the most common news people in respiratory.
This stress began to qualify for oxygen and will look at the delivery of the nonrebreator mask as probably more and the more common methods.
And no time should you have the oxygenated static up, you should always have it laying down and preferably in a bag.
This padded bag would be the perfect application to where When you're ready to get up and go with the patient, all you gotta do is grab the bag, the oxygen cylinders in the bag, and you can move along with the patient whether or not you're ready to transfer them yourself to another location or whether EMS is making the transfer, the the oxygen cylinder is always secure.
So when we take a look at the administration of this auction, I I wanna show a quick video just to visualize this and And so so we back up a little bit.
So, basically, you probably can't hear this, but he's going to cracked a valve.
Right?
Pop it open, make sure there's oxygen.
Now you see the pins, You see the gasket is in place.
It's all the line.
The security is snug.
That's his key.
Don't have to go around, but about one time, look at the gauge, see how much is in there.
Are you sure there's no leaks?
Now we're ready to attach, put it snug, Alright.
So he says 10 to 15, I would go all the way to 15 specifically with an adult.
You gotta fill the bag up first, explain to the patient what you're about to do, and then make it snug to the mass.
Option number 2, we'll talk about the difference here in just a second.
We might need to add a nasal cannula.
This one is 1 to 6 liters per minute.
It does not go around the head.
It goes around the ears, and then you make the adjustment up.
Alright.
I wanna give a good visual on that.
Just to the application.
We started and put a nasal cannula on, cannula.
Cannula.
These are going to flow rate of 1 to 6.
They are not effective and nasal obstructions are present.
They provide a lower oxygen concentration and could be used in cases of of people who have anxiety, who can't tolerate a nonrebreator mask.
Also, you'll find most medical patients.
You're going to be using a nasal cannula like this because you have a lot of questions that you need to ask them and a nonrebreator is not conducive to asking them about allergies, medications, past history, last meal.
So sometimes you leave with this, even though their SPO2 might be low enough to really deliver a higher flow of oxygen, but at least this until you get all of your sample history questions done.
And then then you would gauge whether or not they can tolerate or or are okay simply with claustrophobic and using a nonrebreeder mass.
So you have 2 tools in your two box to use either one of these devices.
You can see here that it has a 100% oxygen.
You gotta make sure that you do that you inflate the bag and the bag does not deflate on you or they are now having negative air pressure sucking in, which is a no no you gotta watch and monitor that that bag stays completely full and that we're delivering a 100% oxygen into that particular patient.
It is possible if you're trying to deliver a high flow oxygen and they do not like that nonrebreator pressed tightly against their that they do a blow bar where you hold it above their mask and you still hold 15 liters per minute, but that allows you to that allows you to I still get a high quality connection to them.
I'm not gonna play this one.
It was basically the same thing.
I'm gonna move on.
We're almost through here and looking forward to your questions.
So bag valve mask.
Again, this is 15 liters per minute hooked up the same way that we just showed you with the other two devices.
You can see there is a padded bag that he has laying on the ground.
He has a regulator attached, and it is full flow, and it fills up the bag and goes straight into the lungs.
Again, this is not your priority.
Opening up the airway, maintaining the airway, AED, chest compressions.
We got a lot of things to do before we get down to putting oxygen.
It is not the number one tool or toolbox in in patient care, but it does need to be administered It's just the timing of when it is administered.
Now in some cases, you might have to use a pocket mask, course, that pocket mask needs an oxygen inlet to it.
But it is device number 4 that could be used in the delivery of auction.
It doesn't give a 100% because it's mixing with your 16% oxygen.
And but you might find a C SPON patient where you need to deliver and use a pocket mask versus a bag valve mask because you're trying to get air around the corner of that upper airway and a bag valve mask is not getting the job done.
And so a pocket mask is always another tool in the toolbox.
That a athlete trainer en masse can utilize.
Alright.
That is that is the overview of Auction And Auction Administration.
And so we'll take a look now at questions and There is my email and it is it is at any point in time You need to contact me or Ray on any of this, please feel free to do so.
So while we still have forty five people hanging in here with us, any is about auction administration.
Let me ask this in the chat out of the 45 people who are listening.
Put yes.
You have option in your scope of practice, put no.
I do not at this current time.
Put a yes if you do and a no, if you don't, if you would.
God, no, yes, no, Munch of nose.
Yeah.
No at the current time.
No.
No.
Practice Act, but not at my high school.
Good.
Good.
Yep.
That's, you know, that's that's what I have been singing and hearing from a lot, I do know that as we talked about in Lainie's presentation as well as Mark and And, Caitlin, that all this equipment really starts to add up OPNP airways, eye gels, back valve mask, adult and child, suction device where you do manual or electronic probably in a kit manual.
And now we just added a cylinder and 4 other devices, a pocket mask as well as a as a as well as a nasal cannula and and a nonrebreathers in multiples of those.
So the kit becomes quite extensive plus the bag needs to typically be green and padded.
And so, yes.
It gets gets to be quite challenging to keep up with all that and make sure it's working and function.
Tom asked if you have o 2 and you do use it or it gets low where where do you get it refill, great question.
I just started searching online to option refill.
I happen to have a a a supplier.
I called him up, said, hey.
Can you fill up my oxygen tanks and then it took them a little bit to recognize that this was non industrial, this was medical.
And then in my state, I needed a letter from a medical director with his license on it, and it was good for 1 year.
And every year, I had to get it refilled.
So you gotta do a research in your community and figure out where they will get refilled.
You know?
Locally, Michigan is refill them, refill you.
Years ago.
Yeah.
Local EMS would would be the one to ask where you get yours filled up, and then start an account in a relationship with that organization.
Again, it used to be incredibly cheap and easy to do, but in recent years, it you there's there's lots more check costs as it should be, and or you get it refilled.
And then they test the cylinders, and now I just when I was there to just exchange them out, The mayor asked a delivery of 02 to a group of soccer players on the bench.
He's at safe.
We're talking about therapeutic oxygen or emergency supplemental oxygen.
So as Mark alluded to in his, those are those are 2 separate those are 2 separate topics to talk about And I'm personally not a big fan of of the therapeutic or the sideline oxygen.
I just just yeah.
That's a lot of work, a lot of I just don't see the benefit from it, and I'm only about the emergency auction.
Alright.
Any other questions as we wrap up this day?
I'm a huge proponent, huge fan of having a fully stocked oxygen kit with all of the things that we talked about and it is a written protocol for every single device, and it is aligned with your scope of practice.
It's aligned with your state all just like somebody ask about the plunger.
Does it work?
Does it not work for for pediatric patients?
And when he has a great statement, like, yeah, it might work, but it's not in our scope of practice.
So you will stay within your lane, and all of this equipment and and information is definitely within the scope of practice and expected standard of care as we take a look at the gap that quite often is happening in Mercy Medicine is constantly expanding, constantly growing, And the expectations of what an athletic trainer should and could do in the emergency setting is constantly growing.
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