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Managing Clinical Cases - CVR > Lecture 1 - Oxygen > Flashcards

Lecture 1 - Oxygen Flashcards

1
Q

What is hypoxia?

A

Reduced oxygen levels at the tissue level measured in SpO2

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2
Q

What are the causes of hypoxia?

A

Reduced cardiac output
Hypoxaemia
Reduced oxygen carrying capacity of the blood
Reduced ability of tissues to extract oxygen
Reduced or disrupted blood flow

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3
Q

What is hypoxaemia?

A

Reduced oxygen in the blood measured in PaO2

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4
Q

What are the causes of hypoxaemia?

A

Wasted perfusion
Wasted ventilation
Hypoventilation
Diffusion problem
Lack of available O2

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5
Q

What is scale 1’s target sats?

A

94-98%

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6
Q

What are some conditions that someone on type 1 might have?

A

Post surgical
Bronchiectasis
Asthma
Pneumonia

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7
Q

What are the target sats for someone on scale 2?

A

88-92%

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8
Q

Why would a patient be on scale 2?

A

Patient at risk of CO2 retention due to chronic hypercapnia, this causes their respiratory drive to switch to a hypoxic drive and then if they are over saturated with oxygen then their respiratory drive may fail

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9
Q

What are some conditions that someone might have if they are scale 2?

A

Chronic asthma
Chronic bronchiectasis
COPD
Cystic fibrosis
Kyphoscoliosis
Neuromuscular diseases

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10
Q

What is considered a critically unwell emergency regarding oxygen sats?

A

If a patient’s oxygen falls below 85%

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11
Q

Describe some risks of over oxygen-saturation?

A

Absorption atelectasis
Impairs respiratory drive of hypercapnic patients
Oxygen toxicity
Cardiovascular changes such as reduced stroke volume and therefore cardiac output

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12
Q

What is absorption atelectasis?

A

Absorption atelectasis is when oxygen becomes the primary gas in the air inhaled instead of nitrogen which is what usually props open the alveoli. The body doesn’t absorb nitrogen but does absorb the oxygen which can lead to collapse.

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13
Q

What is oxygen toxicity

A

Oxygen in the body leads to production of reductive oxygen species which are balanced by anti-oxidants in order to not be harmful. Too much oxygen can lead to this balance being disrupted.

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14
Q

What is the difference between variable and fixed devices for administering oxygen?

A

Variable devices allow you to increase the flowrate by increasing % of oxygen whereas fixed devices require a specific flow rate which you can’t change unless you change the device

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15
Q

How do you set up nasal cannulae?

A

Attach nasal cannulae tubing directly to the oxygen flow and set the flow rate for desired FiO2

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16
Q

What are some pros of nasal cannulae?

A

It’s easy to speak, eat and drink
It’s more comfortable for the patient than a mask
No rebreathing of expired air

17
Q

What are some cons of nasal cannulae?

A

Can dry out nasal mucosa
If patients are mouth breathing it becomes ineffective

18
Q

How do you set up a venturi mask?

A

Attach the desired valve to the simple face mask
Attach oxygen tubing to the bottom of the valve
Attach the other end to the oxygen flow meter
Set the correct flow rate at the oxygen flow meter as it says on the valve
Apply the mask to the patient

19
Q

What are the pros of a venturi mask?

A

Delivers accurate oxygen concentrations - good for patients on scale 2

20
Q

What are the cons of a venturi mask?

A

Drying
Difficult to eat, drink and communicate
Can be uncomfortable

21
Q

How do you set up a non-rebreathe/reservoir mask?

A

Connect oxygen tubing to the mask
Connect other end of tube to the oxygen flow meter
Set flow to 15L/min
Occlude the valve at the base of the mask to allow the reservoir bag to inflate
Put the mask on the patient when the bag is fully inflated

22
Q

Why does the bag need to be inflated to use a non-rebreathe mask?

A

The bag needs to be inflated so that there is a reservoir for gas to be drawn from if respiratory demand exceeds the gas flow being delivered

23
Q

What should you do if a patient’s oxygen sats fall below 85?

A

Use a non-rebreathe/reservoir mask to bring their oxygen sats above 85
Once above 85, titrate down to achieve target sats

24
Q

What are the pros of a non-rebreathe mask?

A

One way valve systems in the mask prevents room air being included in the system dilating the oxygen and prevents retention of exhaled gases during exhalation

Delivers high concentrations of oxygen so is good for emergency treatments

25
Q

What are the cons of a non-rebreathe mask?

A

Very drying due to high flow rate

26
Q

What is the minimum flow for a simple face mask and why?

A

Flow must be at least 5L/min to prevent CO2 from building up

27
Q

How do you set up a simple face mask?

A

Connect oxygen tubing to the mask and to the oxygen flow meter and set flow rate on the wall starting at the minimum and raising as necessary

28
Q

What are the pros of a simple face mask?

A

Used for short periods of oxygen requirement for example post-op patients

29
Q

What are the cons of a simple face mask?

A

Drying
Difficult to eat, drink and talk

30
Q

What flow can be set for a simple face mask and roughly what FiO2 range does this deliver?

A

5-10L/min
35-60% FiO2

31
Q

List fixed methods of administering oxygen

A

Venturi mask
Non rebreathe mask

32
Q

List variable methods of administering oxygen

A

Nasal cannulae
Simple face mask

33
Q

How do you administer cold humidified oxygen?

A

There are various systems that come as separate parts:

Screw the white connector into the top of the oxygen port
Screw the device into the bottom of the oxygen port
Connect elephant tubing to the bore port on the side
Connect the other end of the elephant tubing to a simple face mask
Use the oxygen flow meter to set the required FiO2

34
Q

How do you administer warm humidified oxygen?

A

High flow nasal cannulae

35
Q

What are the benefits of high flow in oxygen delivery?

A
  • It creates lower inspiratory resistance and increases expiratory resistance which leads to a long slow breath enabling time for collateral and alveolar ventilation therefore reducing respiratory rate and work of breathing and creating PEEP
  • Clears air in the upper airways reducing rebreathing of gases high in CO2/depleted of O2 by creating a reservoir with high FiO2 in the nasal cavity
36
Q

Why is airway hydration beneficial?

A

It emulates the moist environment of healthy airways and lungs and helps the mucociliary escalator to aid sputum clearance

37
Q

What type of oxygen delivery should you mostly use for people with tracheostomies?

A

Heated humidified oxygen

38
Q

What flow rate can you set through nasal cannula and what FiO2 will this achieve?

A

1-6L
Begins at 24% on 1L and goes up by 4% with each additional litre

Managing Clinical Cases - CVR (5 decks)

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