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M103 T4 > M103 T4 L6 > Flashcards

M103 T4 L6 Flashcards

1
Q

What are the four sources of oxygen? (CONCENTRATion OWL)

A

o2 Concentrators
Oxygen Cylinders
Wall Supply
Liquid Oxygen

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2
Q

What are six features of oxygen cylinders?

A 
Widely available (home & institutional)
Relatively expensive
Various sizes 
Limited length of supply
Suitable for limited/short duration treatment
Supply 100% oxygen
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3
Q

What are four features of wall supplied oxygen?

A

In hospital only
Central supply piped in to clinical areas
May not be available in all clinical areas (clinic rooms)
Supply 100% oxygen

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4
Q

What are oxygen concentrators used for?

A

at home for patients that need long term oxygen

portable options for when the patient is out

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5
Q

How do oxygen concentrators operate?

A

Molecular sieve- removes nitrogen
Oxygen predominant gas >90% concentration
doesn’t run out
Mains operated machine

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6
Q

What are advantageous features of liquid oxygen?

A

More highly compressed
Larger gaseous volume per cylinder volume - may be easier for people to take outside with them
Allow higher flow rates
Well developed in US & parts of Europe

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7
Q

What are disadvantageous features of liquid oxygen?

A

a bit difficult to to organise

expensive

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8
Q

Why might liquid oxygen be a bit difficult to to organise?

A

patients need to be able to fill them up in their own home so they need to be have some degree of dexterity

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9
Q

How is oxygen delivered to spontaneously breathing patients?

A

Nasal cannulae
Uncontrolled masks
Controlled masks

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10
Q

What units is oxygen delivery measured in?

A

litres per minute

% inspired oxygen

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11
Q

What are beneficial features of nasal cannulae for oxygen delivery?

A

usually well tolerated

patients can talk, eat and take oral medication

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12
Q

What type of patients are nasal cannulae used on?

A

patients with mild hypoxaemia who are not critically ill

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13
Q

What factors does the percentage of oxygen delivered via nasal cannulae depend on?

A

flow rate
respiratory rate
alveolar volume

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14
Q

What are disadvantageous features of nasal cannulae?

A

can’t provide humidified oxygen, so it tends to dry out the nose
can cause a sort of bleeding / crusting
can’t deliver higher flow rates

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15
Q

What are disadvantageous features of uncontrolled simple face masks for oxygen delivery?

A

can’t regulate specific oxygen levels

used less often

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16
Q

What are the flow rates and o2%s via nasal cannulae?

A

1-4L/min (lower frs)

24-40% (= FiO2 of 0.24-0.4)

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17
Q

What is breathed in by the patient when using a nasal cannulae?

A

oxygen
room air
exhaled air in mask

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18
Q

What are the flow rates and o2 %s via Simple uncontrolled masks?

A

fr: 5-10L/min

30-60% O2 (high levels)

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19
Q

What type of patients are uncontrolled masks used on?

A

acutely unwell patients with low oxygen levels

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20
Q

How is the bag in uncontrolled Non-rebreathe masks designed and what does the patient breathe in?

A

the bag has one-way valve stops

oxygen mixing with room air and rebreathing of expired air

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21
Q

What are beneficial features of venturi masks for oxygen delivery?

A

the venturi valve allows for the delivery of a fixed / specific concentration of o2

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22
Q

How are oxygen dosages prescribed?

A

according to a drug chart with target oxygen saturations

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23
Q

In what conditions / patients is oxygen used?

A

acutely or chronically hypoxaemic patients (either who are stable or with acute exacerbation)
palliative use in advanced malignancy
sats <90% and breathless, though often multifactorial

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24
Q

What are the normal oxygen saturation levels for different age groups?

A

Normal young adult average = 96-98%
Over 70yrs age 94-98%
Target in most patients = 94-98%

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25
Q

What could acute breathlessness with hypoxaemia develop into?

A

acute cardiac dysrhythmia & organ failure

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26
Q

How is acute breathlessness with hypoxaemia treated generally?

A

Maximal oxygen treatment

Target SpO2 = 94-98%

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27
Q

Other than using oxygen supplies, how else could airway patency be maintained?

A

Secure and maintain airway patency
Enhance circulation (volume, anaemia, cardiac output)
Avoid/reverse respiratory depressants
Establish reason for hypoxaemia and treat
If not improving, may need ventilation

28
Q

What diseases will put patients at risk of hypercapnia (CO2 retention) if given high dose oxygen? (CHiLD, CWD, NMD, ORH)

A

Chronic hypoxic lung disease
Chest wall disease
Neuromuscular disease
Obesity related hypoventilation

29
Q

What are two examples of Chronic hypoxic lung diseases?

A

COPD

Bronchiectasis / Cystic fibrosis

30
Q

What is an example of a chest wall disease?

A

Kyphoscoliosis

31
Q

What is the compensation mechanism for chronically hypoxaemic patients with COPD who have an acute exacerbation?

A

hypoxaemic drive
if you over-correct their pO2 you may switch off their respiratory drive
Hypoxaemia may still be a risk to them

32
Q

What could not providing o2 to a Chronically hypoxaemic patient with COPD who have an acute exacerbation respiratory drive result in?

A

further CO2 retention
worsening acidosis
Narcosis - reduced level of consciousness
(& death - you can kill the patient with oxygen)

33
Q

What are the aims of oxygen treatment?

A

to maintain modest oxygenation whilst preventing CO2 retention & acidosis
to deliver oxygen by fixed % Venturi o2 masks starting at 24% (controlled o2 therapy)
to reach target saturations of 88-92%

34
Q

How is the response to oxygen treatment measured?

A

frequently checked ABGs
pO2, pCO2, pH measured
Adjust dose of oxygen accordingly

35
Q

What happens if the patient isn’t improving after oxygen therapy?

A

non-invasive ventilation

36
Q

Why not use nasal cannulae?

A

Uncontrolled therapy; potentially dangerous as actual inspired o2% varies according to the patient’s respiratory characteristics

37
Q

What do untreated patients of chronic hypoxaemia develop if not treated with long term o2?

A

pulmonary hypertension
r. ventricular hypertrophy
r. ventricular failure (cor pulmonale)
2o polycythaemia (raised Hb)

38
Q

What are the indications that the patient needs LTOT?

A 
baseline gas levels
COPD patients with pO2 < 7.3 kPa
or
COPD patients with pO2 7.3 < 8 kPa AND:
2o polycythaemia
nocturnal hypoxaemia
peripheral oedema/evidence of r. ventricular failure
 evidence of pulmonary hypertension
39
Q

How is LTOT administered?

A

Provided from an oxygen concentrator
Regional concentrator supply service
O2 treatment for ≥15 hours per day

40
Q

What are the benefits of LTOT?

A

Prevention of deterioration in pulmonary hypertension
Reduction of polycythaemia (raised Hb), in cardiac arryhthmias
Improved sleep quality, renal blood flow, long term survival & QoL

41
Q

What happens in sleep apnoea?

A

the relaxation and narrowing of muscles/tissues surrounding pharyngeal airway

42
Q

What are the physical nocturnal symptoms of sleep apnoea?

A

Snoring (Hx often from partner)
Nocturnal choking/waking with a “start”
Nocturia

43
Q

What are the baseline gas levels that indicate that the patient needs LTOT?

A

COPD patients with pO2 < 7.3 kPa

COPD patients with pO2 7.3 < x < 8 kPa

44
Q

What are the complications of sleep apnoea?

A

Cor pulmonale

Secondary Polycythaemia

45
Q

What is the equation used to calculate the Apnea–Hypopnea Index?

A

AHI = apnoeas + hypopnoeas / total sleep time in hours

46
Q

What do the different AHI scores indicate?

A

Mild: AHI 5–14per hour
Moderate: AHI 15–30per hour.
Severe: AHI more than 30per hour.

47
Q

What other diseases is obstructive sleep apnea associated with?

A 
Hypertension 
Type 2 diabetes
Ischaemic heart disease
Heart failure
Cerebrovascular disease/stroke
Cardiac arrhythmias
Death
48
Q

What are the goals in management of obstructive sleep apnea?

A

to resolve signs and symptoms of OSA
to improve sleep quality
to normalise apnoea-hypopnoea index (AHI) and oHb sat levels

49
Q

What is the management plan for patients with obstructive sleep apnea?

A

can’t drive if excessively sleepy
to treat contributing problems
to review medications - e.g. sedating drugs might be causing weight gain

50
Q

How can sleep apnea be managed?

A

Mandibular advancement devices

Surgery

51
Q

What are the behavioural changes required in the management plan for patients with obstructive sleep apnea?

A

Weight loss
Avoid sleeping supine
Avoid alcohol

52
Q

Describe the CPAP machine

A

a mask that fits over the sleeper’s nose and mouth
the mask is connected to a pump that pumps air into the person’s airways
forces the airways to remain open via intraluminal pharyngeal pressure

53
Q

What is the function of mandibular advancement devices?

A

Hold soft tissues of oropharynx forward

54
Q

When are mandibular advancement devices used to treat obstructive sleep apnea?

A

in patients with mild to moderate obstructive sleep apnea
if it’s the patients preference
if CPAP failed

55
Q

When is surgery used to treat obstructive sleep apnea?

A

Surgery - to remove obstructing lesion and make it easier to breathe

56
Q

In what type of patients is CPAP used to treat obstructive sleep apnea?

A

mild OSAHS AND additional co-morbidities
mild OSAHS and high risk profession (e.g. bus driver)
patients with moderate/severe OSAHS regardless of symptoms

57
Q

In what type of patients is CPAP not used to treat obstructive sleep apnea?

A

patients with mild OSAHS, no additional risk factors who aren’t excessive sleepy

58
Q

What are the advs of CPAP?

A 
the symptoms are resolved
↓ apnoea/hypopnoea
↓ daytime sleepiness
↓ risk road accidents
↑ quality of life
Normalises BP
59
Q

What are the disadvs of CPAP?

A

Adherence an issue
Airway drying/irritation - can humidify
Mask problems - air leak, comfort
Normally life long treatment

60
Q

What is the flow rate and percentage oxygen delivered by Non-Rebreathe uncontrolled masks?

A

15L flow rate

delivers 85-90% (high levels)

61
Q

What is an example of a simple uncontrolled face mask?

A

Hudson mask

62
Q

What is the first line of treatment for acute breathlessness with hypoxaemia?

A

High flow uncontrolled mask

Alter flow and delivery device when stable to lower the oxygen levels

63
Q

If a nasal cannulae delivers 24-40% o2%, what is the FiO2?

A

0.24-0.4

64
Q

What are the morning physical symptoms clinical features of sleep apnoea?

A

Unrefreshing/restless sleep
Morning dry mouth
Morning headaches

65
Q

What are the day time physical symptoms clinical features of sleep apnoea?

A

Excessive daytime sleepiness
Difficulty concentrating
Irritability/Mood changes
Sleeping at inappropriate times

66
Q

What are the levels that should be aimed for in oxygen treatment?

A

pO2 <10
pCO2 falling from peak or maintained <6.0
pH increasing/maintained >7.35

M103 T4 (19 decks)

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