Day 7 A&E Flashcards
Name an example of an inotrope
What is an inotrope
digoxin
clinically, if the word inotrope is used it typically refers to positive inotropes.
- A 38 year old woman is hypoxaemic in the ED.
- Her SpO2 in air was 93%.
- She has been started on oxygen via a nasal cannulae.
Which is the lowest flow rate (L/min) of oxygen that is recommended through a nasal cannulae as emergency oxygen therapy?
Which is the highest flow rate (L/min) of oxygen that is recommended through nasal cannulae as emergency oxygen therapy?
Which is the lowest flow rate (L/min) of oxygen that is recommended through a nasal cannulae as emergency oxygen therapy?
1L/min
Which is the highest flow rate (L/min) of oxygen that is recommended through nasal cannulae as emergency oxygen therapy?
6L/min
The upper range of oxygen delivery from nasal cannulae is a little lower than the output of a simple face mask, but the lower range goes a lot lower than a simple face mask which should not be used below a flow rate of 5 L/min (about 40% oxygen).
What is TCAD
A triple combination antiviral drug (TCAD) regimen comprised of amantadine, oseltamivir, and ribavirin
Which venturi valve is needed to provide an Fi02 of 40%?
What oxygen flow rate is required to produce an Fi02 of 40%?
If you turn up the flow rate above this, will you increase the amount of oxygen that the patient receives?
Which venturi valve is needed to provide an Fi02 of 40%?
red
What oxygen flow rate is required to produce an Fi02 of 40%?
10L
If you turn up the flow rate above this, will you increase the amount of oxygen that the patient receives?
no
A 42 year old woman is hypoxaemic in the ED.
Her SpO2 in air was 90%. She has been started on oxygen via a simple face mask.
What is the flow rate range of a simple face mask?
What is the range of oxygen concentration which can be delivered?
Who is this mask suitable for?
What is the flow rate range of a simple face mask?
- 5-10L/min
What is the range of oxygen concentration which can be delivered?
- This flow rate gives a wide oxygen concentration range, providing an FiO2 from ∼40% to ∼60%
Who is this mask suitable for?
- This mask is suitable for patients with respiratory failure without hypercapnia (type 1 respiratory failure)
- but is not suitable for patients with hypercapnic (type 2) respiratory failure.
What is the difference between type 1 and type 2 respiratory failure?
type 1
- hypoxaemic respiratory failure
- caused by a problem with Oxygen getting into the lungs
- seen as normal CO2 but low Oxygen
type 2
- hypercapnic respiratory failure
- caused by blocking/narrowing/respiratory muscle failure
- seen as low oxygen but high carbon dioxide
When would you use a CPAP?
- type 1 resp failure
- weaning off a ventilator
A 38 year old woman with asthma is wheezy and hypoxaemic.
A non-rebreathe mask has been attached to the piped wall-oxygen and turned on to 15 L/min.
Which is the next action to take before applying the mask to the patient’s face?
(3)
Before putting the mask onto the patient, the valve inside the mask should be held down, allowing the reservoir bag to inflate.
Inflating the ‘bag’ creates an oxygen-rich atmosphere which the patient inspires (maximally 85% oxygen).
Not inflating the bag will provide the patient with a far lower oxygen concentration- in critical illness, this will result in sub-optimal resuscitation and could have serious consequences.
Nasal cannulae
Flow rates
Oxygen delivered
1L/min = 24%
2L/min = 28%
4L/min = 36%
Venturi Masks
Blue flow rate + percentage
White flow rate + percentage
Yellow flow rate + percentage
Red flow rate + percentage
Green flow rate + percentage
Non-rebreather flowrate + percentage
Blue flow rate + percentage
2-4L/min =24%
White flow rate + percentage
2-6L/min = 28%
Yellow flow rate + percentage
8-10L/min = 35%
Red flow rate + percentage
10-12L/min = 40%
Green flow rate + percentage
12-15L/min = 60%
Non-rebreather flowrate + percentage
15L/min = 100%
A 50 year old woman with suspected COVID-19 was severely hypoxaemic upon arrival to the ED.
The cubicles were full so she was placed onto a trolley and given oxygen via a non-rebreathe mask, using the device shown.
Despite this management, she remains profoundly hypoxaemic.
The image shows a non-rebreathe oxygen mask attached to a portable compressor.
This machine is used to deliver bronchodilator nebulisers (e.g. salbutamol or ipratropium bromide).
It drives these therapies through air.
The compressor has no oxygen delivering capacity and oxygen masks must NEVER be attached to them.
A 63 year old woman has had a productive cough and intermittent high temperatures for 48 hours.
She describes feeling exhausted and breathless.
She lives with her wife who is a newsagent and is asymptomatic.
She normally takes amlodipine for hypertension and is otherwise fit and well.
- Temperature 37.9℃,
- P 130 bpm regular
- BP 110/65mmHg, RR 28
- 6L/min via a simple face mask giving SpO2 90% on
What are her target SATS?
How should oxygen be provided to her?
We commonly use two oxygen target ranges in clinical practice:
- 88-92% for patients at risk of hypercapnic respiratory failure`§
- 94-98% for the majority of people (where hypercapnic respiratory failure is not anticipated).
What are her target SATS?
This woman’s oxygen target range is 94-98% because we are not suspecting she has any risk factors for type-2 respiratory failure.
How should oxygen be provided to her?
- She does not appear to be critically ill.
- Therefore, the most appropriate oxygen strategy is to titrate-up her flow rate using the simple face mask.
What is the flow rate of a simple face mask?
What is the oxygen percentage range on a simple face mask?
What is the flow rate of a simple face mask?
5-10L/min
What is the oxygen percentage range on a simple face mask?
40-60%
A 67 year old woman has had a dry cough and intermittent high temperatures for 48 hours.
She describes feeling exhausted and has a headache.
She lives with her husband who is a vicar and is asymptomatic.
She normally takes amlodipine for hypertension and is otherwise fit and well.
Observations show:
- Temperature 37.9℃,
- P 110 bpm regular,
- BP 110/65mmHg,
- RR 28, SpO2 90% on air.
What are her target SATS?
What approach should be taken towards her oxygen supplementation?
What are her target SATS?
- 88-92% for patients at risk of hypercapnic respiratory failure
- 94-98% for the majority of people (where hypercapnic respiratory failure is not anticipated).
- This woman’s oxygen target range is 94-98%.
What approach should be taken towards her oxygen supplementation?
- Start oxygen via nasal cannulae and titrate according to response
- She does not appear to be critically ill.
- Therefore, the most appropriate oxygen strategy is to titrate her oxygen therapy, starting low and working upwards.
- The most appropriate oxygen device to use first is nasal cannula.
A 62 year old woman has had a dry cough and intermittent high temperatures for 48 hours.
She describes feeling exhausted and has a headache. She lives with her husband who is retired and is well.
She normally takes amlodipine for hypertension and paracetamol for back pain but is otherwise fit and well.
Observations show: Temperature 38.9℃, P 140 bpm irregular, BP 90/65mmHg, RR 28, SpO2 78% on air., GCS E3V4M6 (13).
What are her target SATS?
What approach should be taken towards her oxygen supplementation?
This woman’s oxygen target range is 94-98% because we are not suspecting she has any risk factors for type-2 respiratory failure.
Start 15L/min via a non-rebreathe mask
