Oxygen Therapy

Question 1

At what age is this CPG applicable?

Answer 1

12 and older

Question 2

Oxygen is a treatment for _______ not breathlessness.

Answer 2

Hypoxaemia

Question 3

What is the aim of oxygen therapy in acutely ill patients?

Answer 3

To achieve normal or near normal SPO2 by administering oxygen with a target and monitoring the patient.

Question 4

In patients that are acutely short of breath, what is the priority?

Answer 4

Early O2 admin over obtaining an SPO2.

Question 5

If SPO2 is not readily available, what is the management?

Answer 5

Administer 2-6L/m via nasal cannulae or 5-10L/m via face mask until symptoms resolve or SPO2 available.

Question 6

List the 9 critical illness listed in this guideline.

CRITICALS

Answer 6

1. Cardiac arrest
2. Resuscitation
3. Sepsis
4. Major trauma
5. Head injury
6. Ketamine sedation
7. Anaphylaxis
8. Status epilepticus
9. Shock

Question 7

List the 6 conditions associated with chronic hypoxaemia.

Answer 7

1. COPD
2. Cystic fibrosis
3. Severe kyphoscoliosis
4. Bronchiectasis
5. Obesity
6. Neuromuscular disorders

Question 8

COPD should be suspected in…

Answer 8

Any patient over the age of 40 who:

• Is a smoker/history of smoking
• Is experiencing dyspnoea that is persistent, progressive and worse with exercise
• Has a chronic cough
• Has chronic sputum production
• Has a family Hx of COPD

Question 9

Oxygen should not be routinely administered to patients with a normal SPO2. This includes conditions such as…

Answer 9

ACS, stroke and arrhythmias

Question 10

List the 7 circumstances where pulse oximetry may be unreliable.

Answer 10

1. Peripheral vascular disease
2. Severe asthma
3. Severe anaemia
4. Cold extremities (peripheral shutdown)
5. Severe hypotension
6. Carbon monoxide poisoning
7. Severe hypoxaemia (++inaccurate if <80%)

Question 11

What is the O2 therapy for patients who have inhaled toxic gases?

Answer 11

10-15L/m O2, even if no breathlessness.

Question 12

What are the considerations for paraquat/bleomycin poisoning?

Answer 12

Accept permissible hypoxaemia of 85-88%.

Question 13

Irrespective of SPO2, the patient’s ________ should be assess for adequate ventilation.

Answer 13

Tidal volume.

Question 14

O2 exchange is at it’s greatest in what position?

Answer 14

Seated upright.

Question 15

Hypoxaemic women who are >20 weeks pregnant should be managed how?

Answer 15

Left lateral tilt to reduce compression of vena cava, oxygen if further indicated.

Question 16

What is the minimum flow rate for a simple face mask?

Answer 16

5L/min, due to risk of CO2 retention.

Question 17

What SPO2 is associated with mild to moderate hypoxaemia?

Answer 17

85 to 91%.

Question 18

What is the management for mild to moderate hypoxaemia?

Answer 18

Initial dose 2-6L/min via NC, titrate to 92-96%.

Consider simple face mask 5-10L/min.

Question 19

What SPO2 is associated with severe hypoxaemia?

Answer 19

<85%

Question 20

What is the management for severe hypoxaemia?

Answer 20

Initial dose 10-15L/min via NRB (adequate Vt)
BVM with O2 (inadequate Vt)
Once pt haemodynamically stable, titrate to 92-96%.
If deteriorates or SPO2 remains <85%, BVM with O2 and consider SGA.

Question 21

What is the management for a patient presenting with a critical illness?

Answer 21

As per Severe Hypoxaemia:
10-15L/m via NRB, consider BVM if inadequate Vt.
If deteriorates/remains <85%, BVM w/ O2 + consider SGA.

Question 22

What is the management for a chronically hypoxaemic patient presenting with a critical illness?

Answer 22

As per Severe Hypoxaemia:
10-15L/m via NRB, consider BVM if inadequate Vt.
If deteriorates/remains <85%, BVM w/ O2 + consider SGA.
- Once stable, titrate to 88-92%.

Question 23

What is the management for a chronically hypoxaemic patient NOT presenting with a critical illness?

Answer 23

Initial dose 2-6L/min via NC, titrating to 88-92%.
Consider 5-10L/min via SFM.
If pt deteriorates OR SPO2 remains <85%, Rx as per severe hypoxaemia.

Question 24

List the 6 conditions that receive high flow oxygen, regardless of SPO2.

Answer 24

1. Toxic inhalation exposure
2. Decompression illness
3. Cord prolapse
4. Postpartum haemorrhage
5. Shoulder dystocia
6. Cluster headache

All receive 10-15L/min via NRB

Question 25

What is the STOP note in this guideline?

Answer 25

High concentration O2 may be harmful in the COPD pt at risk of hypercapnic respiratory failure.

Question 26

Patients with medically diagnosed pneumothorax but with no intercostal catheter in situ may benefit from..?

Answer 26

High dose oxygen regardless of SPO2.

Question 27

All patients suspected to have inhaled toxic gases (house fires, CO poisoning) should be given…?

Answer 27

High dose oxygen until arrival at hospital, a pts who show no signs of breathlessness may benefit from this treatment.