Oxygen Equipment & Oxygen Therapy

Question 1

Why do we need Oxygen (O2)?

Answer 1

Its essential for life. It combines chemically with glucose (Krebs Cycle) to provide energy for the metabolic processes of the body.

Question 2

Hypoxia

Answer 2

Inadequate Oxygen tension at cellular level

Question 3

Characteristics of Hypoxia

Answer 3

Tachycardia
Hypertension
Peripheral vaso-constriction
Dizziness
Mental confusion

Question 4

Hypoxaemia

Answer 4

An abnormal deficiency in the concentration of O2 in arterial blood

Question 5

Characteristics of Hypoxaemia

Answer 5

Cyanosis
Restlessness
<GCS
Cheyne-Stokes respiration
Apnoea
Hypertension
Tachycardia

Question 6

Cheyne-Stokes respiration

Answer 6

Cheyne–Stokes respiration is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnoea.

Question 7

Hypercarbia

Answer 7

Greater then normal CO2 in the blood

Question 8

O2 Implication in Practice

Answer 8

O2 is a medication and should be treated as such..
Only prescribed & administered to those with clinical need.

Oxygen therapy should be Titrated to achieve normal saturation values in healthy adults(94/98%)

Question 9

O2 is treatment for…

Answer 9

…Hypoxaemia and not breathlessness

Question 10

By increasing the O2 content within the lungs

Answer 10

Haemoglobin is forced to carry more O2. Reversing the effects of Hypoxia on the brain, heart and other vital organs.

Question 11

Hypoxia

Answer 11

deficiency in the amount of oxygen reaching the tissues

Question 12

Oxygen cylinders

Answer 12

O2 is stored in cylinders on ambulances.
In UK O2 cylinders are clearly marked with ‘Oxygen’ or ‘O2’ and charged at 2000psi.
Must be maintained in good working order.

Question 13

Two sizes of O2 cylinder

Answer 13

CD = 460L
HX = 2300L

Question 14

How long does a cylinder last?

Answer 14

Should be changed when a 1/4 full.
Divide capacity of cylinder by flow rate.
(amount in cylinder - 1/4) / (flow rate)

Question 15

O2 use CAUTIONS

Answer 15

Combustible materials ignite easier and burn fiercer in the presence of pure O2.

Oil, Grease, Sparks, Flames or any other type of ignition source may also cause and explosion if it comes into contact with O2 equipment.

Question 16

Health & Safety (1 of 4)

Answer 16

Cylinders must be stored in well ventilated positions in special areas or cupboards provided.

Full and empty cylinders should be kept separate.
The storage area must not be used for any other purpose.

Cylinders should be properly supported off the floor.

Question 17

Health & Safety (2 of 4)

Answer 17

Cylinders should not be allowed to get rusty, dirty, be repainted or have their markings obscured.

Cylinders must not be stored near stocks of combustible and or flammable materials.

warning sings prohibiting smoking or naked lights must be visible.

Adequate access must be provided and maintained to and from storage area.

Question 18

Health & Safety (3 of 4)

Answer 18

No smoking when using O2

Do not use in the presence of naked flames

Exercise care when using O2 in presence of machinery or equipment which can create sparks.

Oil or grease must not come into contact with the outlet, valves or associated equipment due to risk of explosion.

Question 19

Health & Safety (4 of 4)

Answer 19

Newly charged cylinders must have a securely fixed seal on outlet.

The outlet face must not be damaged.

Avoid dropping or rolling cylinders along ground when moving them.

Avoid excessive force when turning the valve key or when connecting and apparatus.

Question 20

Regulators

Answer 20

These are attached to the cylinders to reduce the pressure form 2000psi to around 60psi.

They incorporate a contents gauge and flow meter, attached directly or at the end of piping system, to assist in varying the flow rate of oxygen being delivered to the patient.

Question 21

Free flow O2 therapy

Answer 21

Spinning ball flow-meter - on all vehicles

O-15 Litres per minute

Variable % depending on mask used

Question 22

Non Re-Breather Masks

Answer 22

These masks can be used on all patients who require high concentrations of O2 due to trauma.

There are 2 sizes: Adult & Paediatric

These masks are to be used with a high flow rate of 15 Litres per minute to deliver 100% O2 to the patient.

Ensure that the reservoir bag is inflated prior to use.

These masks are for single patient use and are disposable.

Question 23

Critical Illnesses requiring high levels of supplemental Oxygen (non re-breather 100%)

Answer 23

Shock
Sepsis
Major Trauma
Near-drowning
Anaphylaxis
Major Pulmonary Haemorrhage
Carbon Monoxide Poisoning

Question 24

Critical Illnesses requiring high levels of supplemental Oxygen - General Principles

Answer 24

Initial is reservoir bag at 15 L/min

Once stable reduce O2 to target saturation of 94-98%

Patients with COPD who develop critical illness should receive the same initial saturation targets but will need assessment and further controlled O2 therapy.

Question 25

Nasal Cannulae, Venturi 28% & Tracheostomy

Answer 25

Designed to deliver low to medium flow O2 concentrations.

Question 26

Nasal Cannula

Answer 26

1 L/min = 24%
2 L/min = 28%
4 L/min = 36%
8 L/min = 52%

Question 27

Venturi face mask

Answer 27

4 L/min = 28%

Question 28

Tracheostomy

Answer 28

flow rate = 10 L/min

Question 29

Serious illnesses requiring moderate levels of supplemental O2 if the patient is hypoxic

Answer 29

Acute Hypoxaemia - as yet undiagnosed
Acute Asthma, pneumonia, Ca lung
Post operative breathlessness
Acute heart failure
PE
Pleural effusions (fluid in pleural space)
Pneumothorax (air in pleural space)
Deterioration of lung fibrosis or other interstitial disease.
Severe anaemia
Sickle cell crisis

Question 30

Administration and Dosage

Answer 30

The O2 concentration delivered to the patient is determined by the choice of mask and flow rate.

It is important to administer the correct oxygen concentration & flow rate for the patients condition.

Question 31

COPD and other conditions requiring O2 therapy

Answer 31

COPD
Exacerbation of cystic fibrosis
Chronic neuromuscular disorders.
Chest wall disorders
Morbid obesity

Question 32

COPD and other conditions requiring O2 therapy - General Principles

Answer 32

Prior to availability of blood gases, use 28% venturi mask with saturation target of 88-92%

If saturation remains below 88% use nasal cannulae at 5L/min with target of 88-92%

Patients with alert cards, previous Noninvasive Ventilation or Intermittent positive pressure ventilations or with SpO2 ,88% should be treated as high priority with a hospital pre-alert.

If diagnosis is unknown treat as COPD if;

• over 50
• Long term smoker with chronic breathlessness on minor exertion.

Question 33

Hypoxic Drive - what is it?

Answer 33

The hypoxic drive is a form of respiratory drive in which the body uses O2 chemoreceptors instead of CO2 receptors to regulate the respiratory cycle.

in hypoxic drive an increase in O” will cause chemoreceptor reflexes to trigger a decrease in respirations.

Question 34

Normal Respiration is driven mostly by?

Answer 34

The levels of carbon dioxide in the arteries, which is detected by central chemoreceptors and very little by the oxygen levels.

Question 35

Hypoxic drive - how to administer O2 to COPD patient on domiciliary O2

Answer 35

For known COPD patients on long term (more then 15 hours a day) domiciliary O2. Deliver O2 via nasal cannulae at the flow rate normally used by the patient at home whether the have acute respiratory distress or not.

Question 36

Hypoxic drive - how to administer O2 to COPD patient NOT on domiciliary O2

Answer 36

COPD pat not on domiciliary O2 presenting with acute respiratory distress deliver O2 via nasal cannulae at a concentration of 28% (2Lpm) and monitor O2 saturation - Sats of 92% maybe satisfactory for these patients.

Question 37

Administration and Dosage

Answer 37

For COPD patients who are acutely Hypoxic (body is deprived of adequate oxygen supply) due to causes other then COPD O2 therapy appropriate for that condition should be given until the effects of the hypoxia have been addressed then adjusted to maintain appropriate O2 Saturation levels.

Question 38

Conditions for which patients should be monitored closely, BUT O2 therapy is not required unless hypoxic:

Answer 38

1. myocardial infarction
2. stroke
3. pregnancy and obstetric emergencies
4. hyperventilation or dysfunctional breathing
5. most poisoning and drug overdose
6. paraquat or bleomycin
7. metabolic or renal disorders
8. acuter and sub-acute neurological and muscular conditions producing muscle weakness.

Question 39

Conditions for which patients should be monitored closely, BUT O2 therapy is not required unless hypoxic - GENERAL PRINCIPLES

Answer 39

If the patient is hypoxaemic, the initial therapy is nasal cannulae at 2-6Lpm or simple face mask at 5-10Lpm unless SpO2 is <88% then use reservoir mask/non-rebreather

Question 40

Monitoring O2 therapy

Answer 40

If a patients respiratory rate falls below 10 breaths per minute O2 therapy should be discontinued and the patient monitored for improvement.

If the patients respiratory rate improves O2 therapy should be re-instated at a lower concentration.

If the respiratory rate remains below 10bpm ventilations should be assisted with a bag and mask with supplemental O2

Question 41

Administer with caution

Answer 41

caution should be exercised with neonates.

after prolonged administration of high % O2 a condition termed ‘Detrimental Fibroplasia’ can result

Question 42

Over-Oxygenation

Answer 42

Any patient who is receiving O2 must be monitored and SpO2 reading taken as soon as practicable.

if their respiratory rate drops below 10 breaths per minute then oxygen therapy must be discontinued.

If after 30 seconds, their respiratory rate has not improved, then assisted ventilations via bag & mask with reservoir bag attached and supplemental O2 at a rate of 12 to 15 breaths per minute must be commenced.

Question 43

Reporting

Answer 43

O2 is a prescription only medicine and your are required by law to report its use.

Question 44

You must record on the patient report form:

Answer 44

The concentration given

How long for

Effect of O2 on patient

SpO2 reading (before & after administration)