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Oxygen and Medical Gas Therapy > oxygen and medical gas therapy > Flashcards

oxygen and medical gas therapy Flashcards

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USMLE® Step 1 flashcards
1
Q

what are the 4 types of devices used to delivery of therapeutic gases?

A
  1. reducing valves
  2. flowmeters
  3. regulators
  4. high pressure hose connector
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2
Q

what are reducing valves?

A

reduce high pressures from gas cylinders to lower working pressure 50 psi

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3
Q

what happens when an E tank of oxygen O-ring is missing or the yoke is misaligned on the post?

A

high pressure gas leak will occur when the tank is opened. close off the tank to stop the leak by turning the stem in clockwise direction ( righty-tighty )

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4
Q

flowmeters are used for?

A

gas flow

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5
Q

what is the most common type of flowmeter use in respiratory therapy?

A

Thorpe tube

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6
Q

Being gravity dependent, what position should the Thorpe tube be in?

A

The Thorpe tube is accurate only when in an upright position

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7
Q

Thorpe tubes come in two basic designs?

A
  1. pressure - compensated ( backpressure - compensated)

2. non - pressure - compensated ( non - backpressure - compensated)

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8
Q

Pressure compensated?

A

placement of the flow controlling needle valve downstream from the tapered tube. Needle valve closed, the ball float jumps when connected to 50 psi outlet

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9
Q

Non pressure compensated?

A

needle valve is upstream from tapered tube and back pressure will affect float position such that flow out of the unit will be higher than that indicated

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10
Q

regulators ( aka Bourdon guage)?

A

combine a reducing valve and a flowmeter within single unit

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11
Q

Bourdon guage?

A

unaffected by gravity, making it the flowmeter of choice for patient transport

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12
Q

Bourdon gauge is inaccurate in the face of back pressure?

A

indicated flowrates higher than actually exist

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13
Q

Exam Hint?

A

choose a back pressure compensated flowmeter in all situations except during patient transport, when the oxygen tank and flowmeter might be laid flat. choose a bourdon type flowmeter when a patient must be transport

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14
Q

What are the 2 most common oxygen analyzer?

A
  1. Polargraphic Electrode

2. Galvanic Fuel Cell

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15
Q

Polarographic Electrode

A
  • Clark electrode, similar to that used in blood gas analysis
  • reflects PO2 which converted on a galvanometer display to FiO2
  • requires batteries
  • does not have a gas sampling capillary tube
  • relatively quick response time of 10 - 30 seconds
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16
Q

Galvanic Fuel Cell

A
  • batteries are not required

- slow response time up to 60 second

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17
Q

failure to calibrate either type can be caused by a weak battery, an exhausted supply of chemical reactant in the membrane over the probe?

A
  • A damaged or torn probe will allow water, mucus, or blood onto the probe
  • high altitude causes them to display a lower than true oxygen percentage and high pressure seen on vent with PEEP cause units to display a higher than true oxygen percentage
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18
Q

A two point calibration procedure is done on all oxygen analyzers?

A
  1. 21 % oxygen ( first point or low oxygen check)

2. 100 % oxygen ( second point or high oxygen check)

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19
Q

If results show wandering or analyzer is unresponsive? ?

A
  • change batteries and recalibrate
  • if battery is fresh and problems continue, replace the fuel cell or sensor
  • if analyzer still does not calibrate use another analyzer
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20
Q

what is the primary indication for oxygen therapy ?

A
  • hypoxemia
  • hypoxia
  • decrease PT work of breathing
  • decrease the work of the heart
  • severe trauma
  • carbon monoxide poisoning
  • myocardial infarction
  • shock
  • postanesthesia
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21
Q

Hazards and complications of oxygen therapy include:

A
  • oxygen toxicity
  • absorption atelectasis
  • oxygen induced hypoventilation
  • retinopathy of prematurity
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22
Q

Oxygen toxicity?

A

cellular damage of lung parenchyma ( ALI ) occurs as the result of prolonged exposure to oxygen at level where the FiO2 is greater than 50 %. lung injury worsens over time

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23
Q

Absorption atelectasis?

A

alveolar patency is maintained by nitrogen, makes up 78 % of alveolar air. giving oxygen more than 50% will lead to risk of nitrogen wash out from the lung. if O2 is being removed from perfused alveoli more rapidly than can be replaced seen in PT with low tidal volume, airway obstruction, areas of poor ventilation the alveoli shrink and collapse aka ( absorption atelectasis )

24
Q

O2 - induced hypoventilation?

A
  • PT’s who have an elevated carbon dioxide level and compensated respiratory acidosis caused by severe emphysema, chronic bronchitis, COPD.
  • common goal is to keep the PaO2 level between 50 and 60 torr and SpO2 88 % to 92 %
25
Q

Retinopathy of Prematurity

A
  • AKA retrolental fibroplasia occurs in premature or low birth weight infants with exposure to excessive concentrations of O2
  • scarring and blindness
  • acidosis, hypercapnia, anemia, sepsis
  • minimize risk of ROP , by keeping PaO2 levels maintained below 80 mm Hg
26
Q

Low - flow:

A

variable performance systems that do not meet all of the patient’s ventilatory requirement

27
Q

Low - flow devices:

A

a. Nasal cannula, transtracheal catheter
b. simple face mask
c. partial rebreathing mask
d. nonrebreathing mask

28
Q

Nasal Cannula .20 + ( liters x 0.4) = FiO2

A 
1 = 24 %
2 = 28 %
3 = 32 %
4 = 36 %
5 = 40 %
6 = 44 %
29
Q

Nasal Cannula?

A
  • oxygen flow of 4L/min or less does not require additional humidification if the pt’s has a normal upper airway
  • flowrate greater than 4L/min a bubble humidifier may be used to prevent irritation from drying of the nasal passages
  • 1 to 6L/min for adults
  • for newborns and infants flowrate limited to a maximum of 2 L/min
  • use only on stable PT’s
30
Q

Simple Oxygen Mask

A
  • 6 to 10 L/min should provide 40% to 55% inspired oxygen with a bubble humidifier
  • side ports allow exhalation and provide a degree of safety as the patientis able to breath room air through the openings should the oxygen flow be interrupted
  • flowrates lower than 5 L/min must be void because of retention of CO2
31
Q

Partial Rebreathing Mask

A
  • 10 L/min should provide 60 % to 65 %

- do not let the reservoir bag collapse no more than 1/3 on inspiration

32
Q

Air-Oxygen Blender systems:

A
  • devices uses 50 psig source added with flowmeter
33
Q

Air - oxygen blenders incorporate three distinct functioning components:

A
  1. alarm module - reed sounds a high pitched alarm should one gas source be more than 10 psig greater than the other
  2. pressure - balancing module - balance air and oxygen pressures
  3. proportioning module - meters air and oxygen proportionally to the selected FIO2
34
Q

Troubleshoot any problems with the air - oxygen blender:

A

keep the gas inlets and outlets clear of any debris. The use of filters at gas source inlets helps to prevent debris

35
Q

Molecular sieve oxygen concentrator:

A

flow of 1 L/min delivers at least 90 % oxygen to the patient

36
Q

Heliox uses:

A 
upper airway obstruction 
- tracheal tumor
- laryngotracheobronchitis (croup)
- postextubation stridor
- small endotracheal tube
lower airway obstruction
- status asthmaticus
- may reduce work of breathing
37
Q

Nitric Oxide uses:

A
  • treatment of term and near - term > 34 weeks neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension and increase PVR
  • possible use in acute respiratory distress syndrome (ARDS)
38
Q

NO therapy has largely replaced by?

A

extracorporeal membrane oxygenation (ECMO) therapy as the standard of care for neonates

39
Q

Initial doses of NO?

A

20 ppm

40
Q

what level of dose is when NO2 become toxic and can result in cell damage, hemorrhage, pulmonary edema, death

A

greater than 10 ppm

41
Q

what does is set to be the safety limit of NO2?

A

5 ppm

42
Q

Adverse effects of NO therapy include?

A
  • methemoglobinemia
  • increased left ventricular filling pressure causing increased left heart pressure
  • contraindicated in neonate with cardiac abnormalities
43
Q

Carbogen uses to treat what?

A
  • hypoplatsic left heart syndrome
  • carbon dioxide response curve test ( increase in mintue volume, PFT performed with COPD) and measured by capnometer
  • singultus ( hiccup)
  • pulmonary vasoconstrictor
44
Q

Indications for humidification therapy:

A
  • prevent drying out of the nasal and airway passages
  • prevent inspissated mucosal secretions
  • compromise of mucociliary transport mechanisms
  • prevent humidity deficit because of bypassing the upper airway via intubation
  • treatment of croup, asthma, bronchospasm, thick retained secretions, post - extubation laryngeal edema
  • management of hypothermia
45
Q

Humidification during invasive and noninvasive mechanical ventilation has these recommendation:

A
  1. every pt’s receiving invasive mechanical ventilation should receive humidification
  2. passive humidification ( HME ) is not require during noninvasive mechanical ventilation
  3. active humidification ( wick - type humidifier) is suggested for noninvasive mechanical vent
  4. small VT is being delivered, HME should not be used because it will increase the pt’s dead space and increase PaCO2
  5. HME should not be use as an prevention for VAP
  6. If HME is use during invasive mechanical vent should provide a minimum of 30 mg H2O / L
46
Q

Humidification Devices:

A

Active: add heat or water to the device patient interface
- bubble diffusion humidifier
- pass over humidifier
- bland aerosol nebulizer
Passive: recycle humidified air from the patient
- HME

47
Q

Sputum induction:

A
  • inhales an aerosol 7 % of hypertonic saline solution through ultrasonic nebulizer
  • performed on pt’s with fungal infection, TB, lung cancer
  • hypertonic saline should not be used to obtain a sputum specimen for general bacterial culture
48
Q

Bubble Diffusion Humidifier:

A
  • use with small bore tubing and nasal cannula
  • used on pt’s with a normal upper airway who need some supplemental humidity because of the dryness of medical O2
  • devices usually not heated and deliver gas cooled to below room temperature
  • wraparound type of heater can be added to raise the temperature of the delivered gas and reduce the patient humidity deficit
49
Q

Trouble shooting bubble humidifier problems:

A
  • failure to bubble usually indicates that the lid and the jar are not screwed together tightly or that the delivery tune is plugged. if tube can not be cleared, it must be replaced
  • high pressure pop off or pressure relief valve sounding a high pitched whistle alarm indicated of downstream tubing obstruction
  • valves whistle to signal a gas leak
50
Q

what are the 3 types of pass over humidifier:

A
  1. simple reserivor
  2. wick
  3. membrane
51
Q

simple reservoir humidifier:

A

fisher & paykel MR 850

52
Q

wick type heated humidifier:

A

hudson RCI conchatherm IV ( neptune heater)

53
Q

membrane type humidifier:

A

vapotherm 2000i

54
Q

troubleshoot humidifier devices:

A

any loose connections result in an air leak and loss of tidal volume VT

55
Q

heated and moisture exchangers ( HMEs ):

A
  • artificial nose

- warming, humidification, filtration of inspired gas

56
Q

troubleshoot HMEs:

A
  • secretions or blood coughed into the HME can obstruct the flow of gas and thus make difficult or impossible for the patient to breath. it will increase airway resistance then increasing peak inspiratory pressure ( PIP). The HME should be removed and discarded.
  • HME should not be use on infant because of co2 retention
  • HME should not be used with a pt’s known to cough out large quantities of secretions
57
Q 
An adult patient who suffered a cerebral contusion and resulting cerebral edema from an automobile accident is receiving volume-cycled mechanical ventilation. ABG values are as follows:
pH	7.39
PaCO2	42 torr
PaO2	92 torr
HCO3–	24 mEq/L
BE	0 mEq/L
SaO2	95%
What should the respiratory therapist recommend for the management of this patient?
A

B. Increase the minute volume on the ventilator.

Oxygen and Medical Gas Therapy (1 decks)

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