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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
What could acute breathlessness with hypoxaemia develop into?
acute cardiac dysrhythmia & organ failure
26
How is acute breathlessness with hypoxaemia treated generally?
Maximal oxygen treatment | Target SpO2 = 94-98%
27
Other than using oxygen supplies, how else could airway patency be maintained?
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
What diseases will put patients at risk of hypercapnia (CO2 retention) if given high dose oxygen? (CHiLD, CWD, NMD, ORH)
Chronic hypoxic lung disease Chest wall disease Neuromuscular disease Obesity related hypoventilation
29
What are two examples of Chronic hypoxic lung diseases?
COPD | Bronchiectasis / Cystic fibrosis
30
What is an example of a chest wall disease?
Kyphoscoliosis
31
What is the compensation mechanism for chronically hypoxaemic patients with COPD who have an acute exacerbation?
hypoxaemic drive if you over-correct their pO2 you may switch off their respiratory drive Hypoxaemia may still be a risk to them
32
What could not providing o2 to a Chronically hypoxaemic patient with COPD who have an acute exacerbation respiratory drive result in?
further CO2 retention worsening acidosis Narcosis - reduced level of consciousness (& death - you can kill the patient with oxygen)
33
What are the aims of oxygen treatment?
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
How is the response to oxygen treatment measured?
frequently checked ABGs pO2, pCO2, pH measured Adjust dose of oxygen accordingly
35
What happens if the patient isn't improving after oxygen therapy?
non-invasive ventilation
36
Why not use nasal cannulae?
Uncontrolled therapy; potentially dangerous as actual inspired o2% varies according to the patient’s respiratory characteristics
37
What do untreated patients of chronic hypoxaemia develop if not treated with long term o2?
pulmonary hypertension r. ventricular hypertrophy r. ventricular failure (cor pulmonale) 2o polycythaemia (raised Hb)
38
What are the indications that the patient needs LTOT?
``` 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
How is LTOT administered?
Provided from an oxygen concentrator Regional concentrator supply service O2 treatment for ≥15 hours per day
40
What are the benefits of LTOT?
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
What happens in sleep apnoea?
the relaxation and narrowing of muscles/tissues surrounding pharyngeal airway
42
What are the physical nocturnal symptoms of sleep apnoea?
Snoring (Hx often from partner) Nocturnal choking/waking with a “start” Nocturia
43
What are the baseline gas levels that indicate that the patient needs LTOT?
COPD patients with pO2 < 7.3 kPa | COPD patients with pO2 7.3 < x < 8 kPa
44
What are the complications of sleep apnoea?
Cor pulmonale | Secondary Polycythaemia
45
What is the equation used to calculate the Apnea–Hypopnea Index?
AHI = apnoeas + hypopnoeas / total sleep time in hours
46
What do the different AHI scores indicate?
Mild: AHI 5–14 per hour Moderate: AHI 15–30 per hour. Severe: AHI more than 30 per hour.
47
What other diseases is obstructive sleep apnea associated with?
``` Hypertension Type 2 diabetes Ischaemic heart disease Heart failure Cerebrovascular disease/stroke Cardiac arrhythmias Death ```
48
What are the goals in management of obstructive sleep apnea?
to resolve signs and symptoms of OSA to improve sleep quality to normalise apnoea-hypopnoea index (AHI) and oHb sat levels
49
What is the management plan for patients with obstructive sleep apnea?
can't drive if excessively sleepy to treat contributing problems to review medications - e.g. sedating drugs might be causing weight gain
50
How can sleep apnea be managed?
Mandibular advancement devices | Surgery
51
What are the behavioural changes required in the management plan for patients with obstructive sleep apnea?
Weight loss Avoid sleeping supine Avoid alcohol
52
Describe the CPAP machine
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
What is the function of mandibular advancement devices?
Hold soft tissues of oropharynx forward
54
When are mandibular advancement devices used to treat obstructive sleep apnea?
in patients with mild to moderate obstructive sleep apnea if it's the patients preference if CPAP failed
55
When is surgery used to treat obstructive sleep apnea?
Surgery - to remove obstructing lesion and make it easier to breathe
56
In what type of patients is CPAP used to treat obstructive sleep apnea?
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
In what type of patients is CPAP not used to treat obstructive sleep apnea?
patients with mild OSAHS, no additional risk factors who aren’t excessive sleepy
58
What are the advs of CPAP?
``` the symptoms are resolved ↓ apnoea/hypopnoea ↓ daytime sleepiness ↓ risk road accidents ↑ quality of life Normalises BP ```
59
What are the disadvs of CPAP?
Adherence an issue Airway drying/irritation - can humidify Mask problems - air leak, comfort Normally life long treatment
60
What is the flow rate and percentage oxygen delivered by Non-Rebreathe uncontrolled masks?
15L flow rate | delivers 85-90% (high levels)
61
What is an example of a simple uncontrolled face mask?
Hudson mask
62
What is the first line of treatment for acute breathlessness with hypoxaemia?
High flow uncontrolled mask | Alter flow and delivery device when stable to lower the oxygen levels
63
If a nasal cannulae delivers 24-40% o2%, what is the FiO2?
0.24-0.4
64
What are the morning physical symptoms clinical features of sleep apnoea?
Unrefreshing/restless sleep Morning dry mouth Morning headaches
65
What are the day time physical symptoms clinical features of sleep apnoea?
Excessive daytime sleepiness Difficulty concentrating Irritability/Mood changes Sleeping at inappropriate times
66
What are the levels that should be aimed for in oxygen treatment?
pO2 <10 pCO2 falling from peak or maintained <6.0 pH increasing/maintained >7.35

M103 T4 (19 decks)

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