Chapter 10 Oxygen therapy

Question 1

Oxygen is a drug

Answer 1

given based on need and therapeutic benefit

Question 2

Oxygen can cause harm

Answer 2

oxygen can actually cause harm at reperfusion situations at cellular level.

sometimes oxygen can send other toxins around the body as free radicals

Question 3

Oxygen cylinders

• D
• E
• M
• G
• H

Answer 3

seamless steel or light weight alloy
liters of oxygen:

D= 350 LT

E= 625 LT

M= 3000 LT

G= 5300 LT

H= 6900 LT

Question 4

Color code for oxygen

Answer 4

green or green and white

sometimes stainless steel, and aluminum

Question 5

Oxygen cylinder saftey

Answer 5

cylinders should never be allowed to go below 200 psi

anything below this amount would not be able to push out O2 to a patient.

Question 6

Pressure regulators

Answer 6

oxygen stored in a cylinder at 2000 psi is too much to deliver to a patient. so regulators must be used to bring the pressure down to a workable pressure (30-70 psi)

• on E size cylinders, regulators are secured to the valve assembly.
• E and larger size cylinders are used with a threaded portion on the regulators which can be used for high pressure air systems

Question 7

hazards to oxygen therapy

Answer 7

end stage COPD patients switch the trigger for breaths from high carbon dioxide, to low oxygen become hazards to oxygen therapy.

as high amounts of O2 will prompt the body to stop breathing due to sufficient O2

Question 8

Nonrebreather mask (NRB mask)

Answer 8

flow rate
12-15 liters per min

80-90 % O2 concentrate

Question 9

nasal cannula

Answer 9

1-6 liters per min (no higher than 6)

24-44% O2 concentrate

high flow (above 6 liters) will cause harm to the nasal canal and dry out the nasal mucus membrane

Question 10

partial rebreather mask

Answer 10

9-10 liters per min

40-60% O2 concentrate

used so patients can maintain a certain amount of carbon dioxide in their blood to promote breathing.

-this mask is not typically used in EMS but, is common with patients who use O2 at home.

Question 11

venturi mask

Answer 11

up to a max of 15 liters mer min

24-60% O2 concentrate

mixes O2 with inhaled air. can be adjusted by using different tips allowing for different percentages

exact oxygen delivery

Question 12

Tracheostomy mask

Answer 12

8-10 liters per min

varies and can be set by the patient

-designed to be placed over a stoma or tracheostomy

Question 13

NRB

Answer 13

-non rebreather mask

EMTs best way to deliver high concentrations of oxygen to a breathing patient.

inflate bag first by covering air port in mask

perfect for patients with signs of hypoxia

Question 14

facial injuries

Answer 14

blunt injuries to face frequently result in severe swelling or bleeding that could block or partially block the airway

frequent suctioning may be required, along with airway adjunct or endotracheal tube

Question 15

Intubation

Answer 15

using the endotracheal tube to create an airway on a non responsive patient.

EMT may be requested to assist a paramedic in installing the tube.

-B.U.R.P (Bringing Up and to the Right Position)
a process of assisting medic by maneuvering the vocal cords into view for the paramedic

Question 16

Proper placement of tube during intubation

Answer 16

medics use at least 2 methods to ensure proper placement.

• Auscultation of both lungs and the epigastrium (stethoscope to listen to both lungs with sound only coming from lungs not the epigastrium)
• capnometry (end-tidal C02 detector device)

wrong tube placement is fatal mistake if gone un noticed

Question 17

intubation tube placement

Answer 17

average adult 22 cm mark will be at the teeth

Question 18

intubation ventilation

Answer 18

ventilate about 10 breaths per minute, or every 6 seconds (press then count 5 seconds)

take note of any changes to ventilation pressure, a change in resistance could mean tube has fallen out of place, or something else is wrong.

Question 19

intubation during defibrillation

Answer 19

remove the bag from the tube to avoid the unnecessary weight of the bag on the airway.

Question 20

FROPVD

Answer 20

flow restricted oxygen powered ventilation device

• assisted ventilations at
• 10-12 per minute adult
• 20/min for child or infant

100% O2 and up to 40lit per min
inspiratory pressure release valve opens at approximately 60 cm of water pressure

Question 21

prolonged exhalation

Answer 21

indicates a possible lower airway obstruction

Question 22

prolonged inhalation

Answer 22

indicates a possible upper airway obstruction

Question 23

Positive pressure ventilation

Answer 23

forcing oxygen into lungs when a patient has stopped breathing or has inadequate breathing

Question 24

Decreasing cardiac output

Answer 24

• decreasing cardiac output/ dropping blood pressure

normally the heart uses negative pressure to help fill the chambers of the heart with blood.

when positive pressure is used to ventilate, it eliminates the negative pressure that assists in filling the heart with blood.

to mitigate damage, pressure must be just enough volume to raise the chest

Question 25

dangers of PPV positive pressure ventilation

Answer 25

• decreases cardiac output / drops blood pressure
• gastric distention
• hyperventilation

Question 26

gastric distention

Answer 26

filling the stomach with air/oxygen/pressure

(this causes vommiting, and restricted diaphragm movement

Question 27

hyperventilation

Answer 27

-blowing off too much carbon dioxide can cause vasoconstriction (narrowing of blood vessels)

and limit blood flow to the brain

Question 28

A.T.V

Answer 28

automatic transport ventilator

Question 29

respiratory distress

Answer 29

unusual sounds during breathing

elevated breathing rate, but adequate volume

sometimes normal or pale due to vasoconstriction

sometimes agitated or anxious mental state

Question 30

respiratory failure

Answer 30

unusual sounds during breathing, beware absent sounds

too fast or too slow, irregular breathing. inadequate minute volume

pale, blue, sometimes blotchy (mottled)

altered mental status

Question 31

respiratory arrests

Answer 31

no breathing sounds at all

no breaths

pale or blue

typically unconscious or becoming unconscious

Question 32

pressure regulators

Answer 32

• low pressure flowmeter
• pressure compensated
• constant flow selector valves are in general use in the field

Question 33

pressure compensated flowmeter

Answer 33

this meter is gravity dependent and must be in an upright position to deliver accurate reading

-upright calibrated glass tube in which there is a ball float.

rises and falls according to the amount of gas passing through the tube.

meant to larger oxygen cylinders in the ambulance (M,G,H)

Question 34

constant flow selector valve

Answer 34

this type of flowmeter is gaining in popularity.

-has no gauge, and allows for adjustment of flow in liters per minute

adjusts in stepped increments (2,4,6,8 ect…)

can operate in any position

be used with any cylinder

CAN BE USED WITH NASAL CANNULA OR NON REBREATHER MASK

Question 35

high pressure flowmeters

Answer 35

used for oxygen powered devices

• thumper (CPR machine)
• CPAP & BiPAP devices

indications of high flow is threaded connection on oxygen regulator, or a thick green hose type tubing

Question 36

humidifier

Answer 36

often used on COPD patients or children to make them more comfortable

-steril single use humidifiers are available and preferred

Question 37

oxygen toxicity

Answer 37

lungs react unfavorably to over oxygenation and air sac can collapse

-extremely rare in the field

Question 38

infant eye damage

Answer 38

oxygen over a long period of time can develop scar tissue on retina of eye

Question 39

blind insertion devices

Answer 39

• King lt-d
• laryngeal mask airway (LMA)

to apply a blind insertion device, the head should be in a neutral position, not sniffing position

these blind insertion devices do not have masks

Question 40

dead space

Answer 40

30% of tidal volume