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Emergency Medicine > Hypoxaemia > Flashcards

Hypoxaemia Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Difference between hypoxaemia and hypoxia?

A

hypoxaemia is low oxygen in the blood whereas hypoxia is low in the tissues

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2
Q

2 ways to measure oxygen in the blood?

A

Pulse oximetry or ABG

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3
Q

What is the normal partial pressure of oxygen in the blood?

A

10-14 kPa

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4
Q

How does hypoventilation cause hypoxaemia?

A

Decrease removal of co2, co2 build up in alveoli, reduce o2 in alveoli, reduce gradient and therefore transfer of oxygen into blood, high PaCO2 in blood

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5
Q

How do you correct hypoxaemia caused by hypoventilation?

A

Supplement oxygen

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6
Q

What can cause hypoventilation?

A

CNS depression, drugs like opioids and sedatives, neuromuscular disorders, airway obstruction

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7
Q

How do changes in ventilation and perfusion effect levels of oxygen and co2 in the alveolar sacs?

A

If ventilation reduces but perfusion remains the same, alveoli will have low oxygen high co2
If ventilation remains the same but perfusion decreases then alveoli will have high oxygen and low co2

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8
Q

What 3 conditions causes ventilation perfusion mismatch

A

Obstructive lung disease, interstitial lung disease, pulmonary vascular disease

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9
Q

How do you correct hypoxaemia caused by ventilation perfusion mismatch

A

Moderate oxygen supplementation

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10
Q

What happens to the ventilation and perfusion in PE?

A

large areas of dead space
ventilation but not perfused
Alveoli have high oxygen and low CO2 but cant diffuse

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11
Q

Define what is meant by a shunt?

A

Shunt is when there is no ventilation but perfusion is maintained so hypoxic blood returns to heart

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12
Q

Causes of shunt in the lungs?

A 
atelectasis
collapsed lung
pulmonary oedema
secretions (infective or not)
blood
cancer
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13
Q

What are the main reasons for a shunt occuring?

A

Collapsed alveoli
Alveoli filled with a fluid
PE

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14
Q

Name 2 conditions cause abnormal diffusion and therefore hypoxaemia? When are symptoms noticed to be worse?

A

Interstitial lung disease
Fibrosis
Noticed to be worse on exercise as perfusion faster and ventilation isnt

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15
Q

reduced inspired o2 occurs in what conditions?

A

high altitudes

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16
Q

If a patient presents as hypoxaemic what are causative signs are you initially checking for whilst performing ABCDE?

A

Are they hypoventilating? sedatives? airway obstruction?

Mechanical issues/shunting? rib fractures? pneumothorax? atelectasis? collapsed lung? pleural effusion?

17
Q

If the cause of hypoxaemia is by full or collapsed alveoli, what do you do instead of oxygen supplementation?

A 
Sit patient upright
deep breaths and cough
pulmonary oedema - diuretics
Infection - culture and antibiotics
Incentive spirometer
Physio
Treat pain
High flow nasal oxygen -airvo
CPAP or NIV
18
Q

When do you consider a referral to critical care for hypoxaemia?

A

IF they are on 60% FiO2/Airvo and remaining hypoxaemic or if they are failing

19
Q

What 3 investigations would you consider in someone with hypoxaemia?

A

ABG, CXR, CTPA

20
Q

How should the FiO2 correspond to the PaO2/sats

A

Their FiO2 should be 10 more than their PaO2

21
Q

If a patient is on oxygen, what information is it important to give alongside their oxgen sats or PaO2?

A

The concentration of oxygen they are inhaling

22
Q

Example of a high flow nasal oxygen that can be given?

A

Airvo

23
Q

What does Airvo do? Who is it useful for?

A

Fills the upper airways with a low level CPAP system
Useful for short of breath who have increased minute ventilations of over 15l/min as supplementary oxygen wouldnt provide enough and they’d end up diluting with room air

24
Q

Why is high flow nasal oxygen limited to 60% oxygen?

A

risk that using HFNO needs steadily increasing FiO2 as demands increase to the point that a sudden deterioration in patient condition wouldnt have any residual increase in oxygen left to help so limit unless emergency

25
Q

If someone is started on high flow oxygen who should be informed?

A

Senior on call

26
Q

Who is high flow oxygen most useful for?

A

Extremely SOB who have minute ventilations of 15L/min

Emergency Medicine (5 decks)

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