exam 1 - resp support Flashcards
what is the primary indication for oxygen therapy
hypoxia
what is hypoxia
inadequate inspired oxygen
impaired pulmonary function
ineffective oxygen transport
increased oxygen demand not met by delivery
what values determine need for oxygen therapy
PaO2 < 60 mmHg
SpO2 < 90%
clinical signs for needs for oxygen therapy
cyanosis, dyspnea, tachypnea, tachycardia, anxiety
when to use flow-by oxygen
until another method can be employed
shock
which is better - baggie or face masks
baggie - better tolerated
what can an oxygen hood be made from
from an E-collar, or can be bought
what form of oxygen therapy uses alot of oxygen and can lose it very quickly
oxygen cage
when to use oxygen tent
sedated or depressed patient
short term immediate post op
when to use intranasal oxygen
prolonged management
when to use intratracheal oxygen
not common but used if contraindications are found for nasal
should you use intratracheal oxygen with a tracheal obstruction
no
does nasal or tracheal get more bang for buck
tracheal
what are guidelines only for O2 administration
FIO2 and PaO2
what flow rate do you start at
50-100 ml/kg/min
oxygen flow rates should be adjusted based on
SpO2 and PaO2
PaO2 above 100 mmHg
which oxygen administrations can reach FIO2 greater than 50-60%
bilateral intranasal and intratrachea via tracheostomy
what new oxygen administration can prevent ventilation and control FIO2
high flow oxygen
how to monitor oxygen therapy
CS - respiratory rate/character, MM color
pulse ox
arterial blood gas
where to put pulse ox on normal vs critical patients
tongue for normal
buccal mucosa for critical
how does pulse ox work
red light absorbed by unsaturated Hg
infrared absorbed by oxyhemoglobin
how to wean from oxygen therapy
monitor CS, SpO2, serial arterial blood gas, trials off oxygen
when to continue oxygen
CS of hypoxia, SpO2 < 96%, PaO2 < 80 mmHg
oxygen therapy complications
apnea in patients with severe respiratory disease, intrapulmonary shunting, oxygen toxicity
what does oxygen toxicity look like
reasons to put on oxygen
edema, atelectasis, consolidation, congestion, hemorrhage, fibrosis, functional impairment
pathogenesis of oxygen toxicity
cytotoxic peroxides and free radicals
starts after 24 hrs of 100% FIO2
death after 2-3 days 100% FIO2
indications for positive pressure ventilation
PaCO2>55 mmHg
failure of oxygen therapy to reverse hypoxia
adjunctive treatment for intracranial hypertension
2 overall techniques of positive pressure ventilation
manual - anesthesia bag, ambu bag
mechanical - controlled vs assisted, pressure vs volume related
difference between controlled and assisted mechanical ventilation
controlled - machine initiates breath
assisted - animal initiates breath
what is PEEP
positive end expiratory pressure
what is CPAP
continuous positive airway pressure
what do you use to treat alveolar collapse
PEEP or CPAP
decreases work of breathing
usual settings for PEEP or CPAP
5-10 cm H2O
specific instances where PEEP or CPAP indicated
100% oxygen doesnt achieve normoxia
greater than 50% inspired oxygen is required to maintain normoxia - puts at risk for oxygen toxicity
when would you use high frequency ventilation
ventilaiton in presence of tracheal disruption
is high frequency ventilatin used often in vet med
no - not available
how to wean from ventilation
once stable, gradual reduction in minute ventilation so that spontaneous ventilation can start
what to monitor when weaning from ventilation
blood gas, SpO2, ETCO2, respiratory pattern
where does air get humidified in the body
nasopharynx and tracheobronchial tree
effects of dry medical gases
increased humidification requirement
increased vaporization - cooling of liquid surfaces and patient heat loss
mucosal drying
4 types of humidifiers
bubble
heated bubble
humidity exchange filters
nebulizers
aerosol
fine suspension of liquid droplets in carrier gas
what is the purpose of aerosol therapy
prevent dessication - water
loosen secretions and stimulate coughin - saline
treat resp disease - drugs
how does size of particles in aerosols affect deposition
smaller particles deposit deeper in the airway
how does rate and depth of breathing affect aerosol deposition
slow, deep breath = deep airway
rapid, shallow = upper
3 types of nebulizers
jet, babbington, ultrasonic
how to administer aerosol therapy
mask, enclosure, breathing circuit
for 15-20 min q 4-8 hrs
can also couple with coupage, bronchodilators
what is a convenient way to deliver aerosols to lower airways in hospital setting
thru tracheostomy
drugs delivered via nebulization
Abx - aminoglycosides
bronchodilators - aminophylline, beta 2 agonists
