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Basic Principles N928 > Oxygen Therapy > Flashcards

Oxygen Therapy Flashcards

1
Q

Oxygen Delivery Equation

A

DO2= CO x Arterial O2 content

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2
Q

Failure of O2 delivery can be d/t

A

hypotension
acidosis
coagulopathy

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3
Q

Oxygen Use equation

A

VO2=CO x O2a-O2v

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4
Q

Oxygen extraction ratio

A

normal 25%

heart has very high demand

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5
Q

Hypoxemia definition

A

deficiency of O2 in the blood

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6
Q

Hypoxia definition

A

O2 delivery to tissues not sufficient to meet metabolic demand

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7
Q

Anesthesia Oxygenation goal

A

maintain oxygenation and ventilation

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8
Q

Oxygen therapy is

A

the prevention and correction of hypoxemia and tissue hypoxia

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9
Q

Surgical patients are at an increase risk of

A

hypoxia/hypoxemia

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10
Q

Main causes of hypoxemia

A

V/Q mismatch (not enough blood flow or oxygen to the lungs)
R to L shunt (blood entering L side of heart w/o being oxygenated first
diffusion impairment (impaired movement of oxygen from the lungs into the bloodstream)
hypoventilation (shallow and ineffective breathing)
low environmental oxygen

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11
Q

Main causes of hypoxia

A 
any condition or event that reduces O2 intake
asthma
lung disease
heart disease
anemia
high altitudes
carbon monoxide or cyanide poisoning
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12
Q

Hypoxic Hypoxia

A

pulmonary diffusion effect

Drug overdose, COPD, emphysema, asthma, ateletasis

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13
Q

Hypoxia d/t circulatory

A

reduced CO

CHF or MI

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14
Q

Hypoxia d/t Hemic

A

reduced hemoglobin content

carboxyhemoglobinemia, methemoglobinemia, anemia

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15
Q

Hypoxia d/t demand

A

increased O2 consumption

fever, seizure, shivering, mH

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16
Q

Hypoxia d/t histotoxic

A

inability of cells to utilize oxygen

cyanide toxicity

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17
Q

Hypoxia Signs and Symptoms

A 
vasodilation
tachycardia
tachypnea
cyanosis
confusion
lactic acidosis
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18
Q

Methods to improve oxygenation of MV patients

A 
treatment needs to be tailored to cause
increase Ve
increase CO
increase CaO2
optimize V/Q relationship
increase FiO2
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19
Q

Supplemental O2 for non-intubated patients

A

nasal cannula
simple face mask
face mask with reservoirs
venturi masks

20
Q

Nasal cannula

A

flow rates 1-6L/min

FiO2 increases about 4% per L/Min

21
Q

Simple Face Mask

A

FiO2 40-60%
minimum 6L flow required to prevent rebreathing
Minimum is whatever patient’s Mventilation is

22
Q

Face mask with reservoirs

A

FiO2 60-100%

23
Q

Venturi Masks

A

more precise FiO2

24-50%

24
Q

Oxygen Toxicity

A

High FiO2 over long periods can be harmful to lung tissue

25
Q

What lung tissue damage is seen from O2 toxicity

A

decreased ciliary movement
alveolar epithelial damage
interstitial fibrosis

26
Q

O2 toxicity is dependent on

A

FiO2, duration and patient susceptibility

27
Q

safe vs toxic O2 therapy

A

Safe 100% O2 up to 10-20 hours

Toxic: 50-60% O2 for more than 24-72 hours

28
Q

High Risk O2 Toxicity Patients

A

> 70 Ys
PMH: radiation to chest lunge
glicomyocin

29
Q

S/S of Oxygen Toxicity

A 
cough
dyspnea
rales
hypoxia
decrease diffusion
increase in the arterial alveolar gradient
30
Q

Absorption Atelectasis

A

nitrogen is replaced by oxygen
under ventilated alveoli have decreased volume
due to greater uptake of oxygen
increases pulmonary shunting

31
Q

Induced Hypoventilation

A

chronic CO2 retainers rely on hypoxic drive
peripheral chemoreceptors are triggered by hypoxemia
increased O2 can lead to hypoventilation

32
Q

Fire Hazard

A

O2 can support combusion

use extreme caution with head and neck cases

33
Q

Retinopathy

A

O2 therapy in neonates can lead to vascular proliferation fibrosis retinal detachment and blindness

34
Q

Population at risk for retinopathy

A

< 36 weeks gestational age
weight <1500gm
up to 44wks gestational age are considered high risk
safe O2 administration PaO2 60-80mmHg

35
Q

hypercapnia

A

increased Co2 >45mmHG

36
Q

Causes of hypercapnia

A

increased Co2 concentration
increased CO2 production
increased alveolar dead space
decreased alveolar ventilation

37
Q

Increased alveolar dead space

A

decreased alveolar perfusion
interruptions in pulmonary circulation
pulmonary disease

38
Q

Decreased alveolar ventilation

A

can be central or peripheral

respiratory depression most common cause in immediate postoperative period

39
Q

Clinical manifestations of Hypercapnia

A

directly produces vasodilation of peripheral vessels
indirectly increase hR after catecholamine release
produces effects due to acidotic state

40
Q

Nonspecific signs of hypercapnia

A

headache, N/V, sweating, flushing, shivering, restlessness

41
Q

CNS Considerations for hypercapnia

A

regulation of ventilatory drive

cerebral blood flow

42
Q

Cardiovascular considerations in hypercapnia

A

depression of smooth muscle and cardiac muscle
increased catecholamine release
vasodilation vs vasoconstriction

43
Q

pulmonary consideration in hypercapnia

A

increased RR
increased pulmonary vascular resistance
right shift in Hgb dissociation curve

44
Q

treatment of hypercapia

A

adjustment to the cause

increase minute ventilation

45
Q

hypocapnia

A

CO2 less then 35mmHg

cause is usually iatrogenic

46
Q

Manifestations of hypocapnia

A

decrease CBF
cardiovascular decrease in CO, coronary constriction
hypoxemia may result from hypoventilation

47
Q

treatment of hypocapnia

A

decrease minute ventilation

Basic Principles N928 (10 decks)

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