Question: I have some questions regarding supplemental oxygen. For a patient who requires oxygen, but is vomiting frequently is a nasal cannula an adequate oxygen delivery system, or should a Non Rebreather be continually removed an reapplied as necessary? Also I see a wide range of flow rates applied to the nasal cannula (anywhere from 2-8 lpm). What flow rate is most beneficial to a patient in a pre-hospital setting who requires supplemental oxygen via nasal cannula?

 Thanks for asking this question. Oxygen administration is a "hot topic" these days throughout the medical literature. We now know that too much oxygen may not be good and perhaps we need to rethink some of our indications for high flow oxygen.

For now, oxygen administration is governed by the Basic Life Support Patient Care Standards (BLS-PCS) and paramedics should comply with the directions therein. To answer your specific question however, if a patient is recurrently vomiting and oxygen is indicated, then either approach is reasonable: removing the non rebreather to suction as required or using nasal cannula. The only concern with the mask is if someone is vomiting, it may increase the risk of aspiration so the patient needs to be monitored closely.

As a glimpse to the future, our provincial regional base hospital partners have been very busy this year reviewing the latest literature regarding oxygen and specifically hyperoxia, and then painstakingly comparing their findings to the current standards within the BLS-PCS. Look for revised indications in the near future regarding oxygen administration!

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