medical gas therapy

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What are the three indications for Oxygen Therapy

Hypoxemia, Increase WOB, Icreased Miacardial work

3 goals of Oxygen Therapy

treat or prevent hyoxemia, decreased work of breathing, decreased myocardial work

3 ways to assess the need for Oxygen Therapy?

Lab Measurments (ABG, SPO2) Clinical indicators (COPD MI) Bedside assessment (level of concesinous color etc)

Air is made up of?

20.95 % Oxygen and 78.1% nitrogen

what is room air FIO2

21%

4 precautions/possible complications when adminstering Oxygen

1. Oxygen induced hypoventilation (Respiratory Depression) Absorbtion Atelectasis 3. Retinopathy of prematurity ROP 4. Oxygen toxicity

What levetoy do you want to keep to avoid oxygen induced hypoventilation

Maintain PAO2 between 55-65 torr FIO2 should not exceed .28%

What levels do you need to maintain to avoid ROP

Maintain PAO2 < 80 torr

What level do you need to maintain to avoid oxygen toxicity

FIO2 < 60%

What are the 6 clinical signs for oxygen toxicity

cough, substernal pain, dyspenia, lethargy, vomiting, refectory hypoxemia

What is the goal of o2 therapy?

to use the lowest possible FIO2 while monitoring the PaO2 to be sure of adequate tissue oxygenation

how often do you monitor a patient receiving a FIO2 <40%

within 12 hours of initiation

how often do you monitor a patient with a FIO2 > 40%

within 8 hours

How often do you monitor a patient with acute MI

within 72 hours

How often do you monitor a patient with COPD

within 2 hours

how often do you monitor a neonate

within 1 hour

what are the two categories for the devices of Oxygen Therapy

Low flow or High flow

In order to determine which device to use, you must know

how much oxygen the device can deliver and whether the FIO2 remains fixed or varies with changing patient demands

Define low flow

a system that has an unpredictable and variable because of its design and it doesn't meet the patients inspiratory demands

What are the indications for a low flow system

RR < 25, Regular and consistent breathing pattern, tidal volume between 300-700ml

Define nasal canula

consist of 2 prongs connected to small-bore tubing

What is the FIO2 and corresponding L flow for nasal canula

1 L = .24, 2L = .28, 3L= .32, 4L=.36, 5L=.40 6L=.44

when do you use humidity with a nasal canula

flows>3 or when the patient complains of nasal drying

what are the conveniences of the NC

you can talk, able to eat and drink, more comfortable

define nasal catheter

a soft plastic tube with several holes at the tip inserted gently into a nasal passage until visualized behind and above the uvula, it is then taped to the bridge of the nose

what is the gas flow of a nasal catheter

1/4 to 8 LPM, FIO2 0.22-0.44

what are disadvantages of the nasal catheter

possible gagging/air swallowing resulting in aspiration and difficult to insert

when is a nasal catheter used

when a NC is difficult to use (bronchoscopy) or for long term infant therapy

define transtracheal catheter

surgically inserted into the trachea and held in position by a chain necklace, small bore tubing is connected to a flowmeter.

what is the gas flow for the transtracheal catheter

1/4 to 4 LPM FIO2 0.22-0.35

What is the advantage of the transtracheal catheter

increased patient mobility

what are the disadvantages of transtracheal catheter

high cost for the surgical procedure, risk of infection

what is the gas flow for the simple mask

Gas flow 5-12 LPM FIO2 0.35 to 0.55

what is the minimum flow rate of a simple mask and why

5 l per min to prevent CO2 rebreathing

what is the gas flow for the partial rebreathing mask

8-15 lpm FIO2 0.35 to 0.60

On a PRB flow rate should be set so that what happens

bag collapses no more tha 1/2 on inspiration

what is the gas flow for the Non Rebreathing Mask

8-15 LPM FIO2 100%

What makes a device high flow

it is designed to provide for the patients insperatory demands

When are high flow systems indicated

whenever consistent and predictable FIO2 is required and when patient does not meet low flow criteria

define Venturi Mask AEM

has exhalation ports on mask, an injector used to set the FIO2 and a reservoir

explain the settings on the AEM

gas flow depends on FIO2 ordered, FIO2 0.24 to 0.50, the venture entrains room air into ports, it is the most precise means of delivering 02, FIO2 will vary with back pressure (caused by resistance to flow)

FIO2 on AEM at 3LPM

24, 28, 26, 31

FIO2 on AEM at 6 LPM

35, 40, 50

FIO2 on the air entrainment nebulizer

28, 35, 40, 50, 70, 98

what is the use for an air entrainment nebulizer

adds humidity to artificial airways, setting up aerosol mask, t adaptor and face tent

what are the gas flows for an aerosol mask

8- 15 lpm FIO2 0.21-1.0 (mist should show at all times)

When is a Face tent used

used primarily for patients with facial trauma or burns, or those who can not tolerate a mask

what are the gas flows for a face tent

8-15 lpm FIO2 0.21-0.40

When is a T adaptor used

on intubated and trached patients

What are the gas flows for a T adaptor

8-15 lpm FIO2 0.21-1.0

What must also be used with a T adaptor

a 50 ml (6") reservoirt tubing to prevent air from entering T-piece decreasing FIO2 to patient

what are the gas flows for a Trah mask/colllar

10-15 lpm FIO2 0.35 -0.60

what is the calculation for determining patient's inspiratory demands

(VT x RR) = Ve x 3 = inspiratory demands in liters/ minute

What are hazards/complications of Oxygen devices

Fire, Dehydration, Aspiration, Disconection, Pressure ridges, reddened skin

How can you minimize or eliminate hazardss/ccomplicattions

by proper set up of equipment and timely patient equipment checks at least once per shift

what should be checked during a patient equipment check

Connections, water levels, humidity can be seen, bag on NRB and PRB, flow meter and mist is on correct setting, RR and WOB, SPO2, check for vommit

oxyhood (head box) gas flows should be set at

a minimum of 7lpm to prevent accumulation of CO2 FIO@ 0.21 to 1.0

what are the disadvantages of the Oxyhood

high noise levels, reduced visibility, damp bedding under infants head inaccessibility to infant for good nursing care without loss of FIO2

what is a Croupette

a clear plastic canopy with back housing container for ice, and a jet nebulizer

what are the gas flows for a croupette

12-15 lpm, FIO2 can be maintained at about 0.40

Disadvantages of a Croupette

pooling of FIO2 at bottom of enclosure causing FIO2 to be higher, if edges of tent are not sealed tighttley, FIO22 will bbe inconsistent

what is a Isolette (incubator)

a clear, plexiglass chamber with ports on the sides to access the infant

What are disadvantages of the Isolette

Unstable FIO2s and has mainly been replaced by the oxyhood and servo-controlled radiant warming heaters,

WHen is an Isolette your best choice

infants needing a NTE only

What is a oxygen tent

a plastic sheet canopy similar to the croupette in function and design only much larger

gas flow of the oxygen tent

12-15lpm provides FIO2 of 0.40-0.50

what are hazards of enclosures

fire, toys must be limited to stuffed animals that can not ignite a fire, suffocation

Oxygen Analyzer

Analyzed FIO2 to check accuracy, calibrated at 21 and 100%, to check the FIO2 that the patient iss actually reeceiving FIO2 analysis should be performed as close to the pattient ass possible

Oxygen Blenders

Used when the conventional AEN are unable to meet the patients inspiratory demands, provide flow inn excesss of 60lpm, aare pron to inaaccuraccy and ffailure so should be monitored uusing an 02 analyzeer att least oonce per shift

Tandem AEn

used when a single air entainment unit does not meet the patients inspiratory demand 2 units may be combinedd en tanndem to provide the requireed FIO2

hypoxemia

an inadequate amount of oxygen in the blood

Two types of hypoxemia

Responsive, and Refactory

Hypoxia

is inadequate amount of oxygen to the tissue (dependent on ventilation of the lungs, diffusion into the blood, traansportaation of 02 to the tissue, and upttake and utilizzation off 02 att the cellular level

anemic hypoxia

the capacity of the blood to carry 02 is decreased Example Carbon monoxide poisoning treatment ggive 100% 02 viaa NBR, or HBO

Stagnet Hypoxia

(Circulatory) 02 content and carrying capacity are normal but capillary perfusion is diminished

histotoxic hypoxia

inability of tissue to utilize 02 (ex alcohol poisoning)

hypoxemia hypoxia

lack of 02 in the blood

Hyperbaric Oxygen Therapy HBO

uses a special chamber to deliver therapeutic oxygen at pressures greater than 1 atmosphere

what are indications for HBO

Decompression sickness, Gas or air embolism, CO poisoning, Cyanide poisoning, problem healing wouunds, iscchemic skin grafts, trauumatic crush injuries,, necorotizzing soft tisssue infection, gangrene

Complications and hazards of HBO

barotrauma, oxygen toxicity, fire, sudden decompression, claustrophobia

what are indication fo Heli/Ox

To manage large airway obstruction like COPD, acute upper airway obstruction of various origin, post exxtubation stridor in pediatrri trauma patients, refactory viraal crop

what is the mixture of Heli?ox

must be mixed with at least 20% oxygen most common mixture is 80% helium 20% oxygen 70/30 if trreating hypoxemia

what are the conversion factors for Heli/ox

80/20 = 1.8 70/30=1.6

what are hazords and complications for Heli//ox

impaired secretion clearance, distorted high pitched voice, hypoxemia

what are indications for Carbon Dioxide/Oxygenn

stroke, Migraines, stop seizure, CO poisoning

How does CO2/02 work

by increasing cerebral blood flow

what is the CO2/02 mixture

5/95 No more than 5% CO2 should ever be used

side effects of CO2/02

increased HR, Cerebral vasodilatation, dyspnea, dizziness, headache, muscle tremors, nasal irritation

side effects of CO2 toxicity

nausea, vomiting, disorientation, elevated BP

Contraindications for CO2/02

compromised central respiratory centers, severe COPD

indications for Nitric Oxyde

Persistent Pulmonary Hypertension of the newborn, cardiac and lung transplant, acute pulmonary embolism, CCOPD and chronic ffibroosis, bronchodialation, conngeital ddiaphragmatic hernnia, ccongenitall heart disease, ARDS

indications for Home Oxygen

SA02< 88% PaO2 55 or lower, or SAO2 < 89% PaO2 56-59 with diagnosis of specific disease

what should be considered when choosing a hhome oxygeen systtem

liter flow, duration of usage, patients mobility, daily activities, patients strength, eye sight, and ability to read and understand written insturctions

what cylinder can be used for home oxygen and when shoulld they bee used

a-k, when it is low flow 0.5-2 lpm less than 24 hours per day or on prn basis

when should a liquid oxygen system be used

for active patients with liter flows of 0.5-6lpm and a prescription for use > 12 hours per day

When is a concentrator good for home oxygen

home bound patients with letter flow of 1-5 lpm with prescriptions for use >24 hours per day

how does a concentrator work

draws in room air, then physically separates the nitrogen from the oxygen and stores the oxygen in a small accumulator

how is the separation process accomplished in a concentrator

throgh a molecular sieve that contains sodium-aluminum silicate pellets that absorb nitrogen, carbon dioxide and water vapor

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