Oxygen Therapy Flashcards
At what age is this CPG applicable?
12 and older
Oxygen is a treatment for _______ not breathlessness.
Hypoxaemia
What is the aim of oxygen therapy in acutely ill patients?
To achieve normal or near normal SPO2 by administering oxygen with a target and monitoring the patient.
In patients that are acutely short of breath, what is the priority?
Early O2 admin over obtaining an SPO2.
If SPO2 is not readily available, what is the management?
Administer 2-6L/m via nasal cannulae or 5-10L/m via face mask until symptoms resolve or SPO2 available.
List the 9 critical illness listed in this guideline.
CRITICALS
- Cardiac arrest
- Resuscitation
- Sepsis
- Major trauma
- Head injury
- Ketamine sedation
- Anaphylaxis
- Status epilepticus
- Shock
List the 6 conditions associated with chronic hypoxaemia.
- COPD
- Cystic fibrosis
- Severe kyphoscoliosis
- Bronchiectasis
- Obesity
- Neuromuscular disorders
COPD should be suspected in…
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
Oxygen should not be routinely administered to patients with a normal SPO2. This includes conditions such as…
ACS, stroke and arrhythmias
List the 7 circumstances where pulse oximetry may be unreliable.
- Peripheral vascular disease
- Severe asthma
- Severe anaemia
- Cold extremities (peripheral shutdown)
- Severe hypotension
- Carbon monoxide poisoning
- Severe hypoxaemia (++inaccurate if <80%)
What is the O2 therapy for patients who have inhaled toxic gases?
10-15L/m O2, even if no breathlessness.
What are the considerations for paraquat/bleomycin poisoning?
Accept permissible hypoxaemia of 85-88%.
Irrespective of SPO2, the patient’s ________ should be assess for adequate ventilation.
Tidal volume.
O2 exchange is at it’s greatest in what position?
Seated upright.
Hypoxaemic women who are >20 weeks pregnant should be managed how?
Left lateral tilt to reduce compression of vena cava, oxygen if further indicated.
What is the minimum flow rate for a simple face mask?
5L/min, due to risk of CO2 retention.
What SPO2 is associated with mild to moderate hypoxaemia?
85 to 91%.
What is the management for mild to moderate hypoxaemia?
Initial dose 2-6L/min via NC, titrate to 92-96%.
Consider simple face mask 5-10L/min.
What SPO2 is associated with severe hypoxaemia?
<85%
What is the management for severe hypoxaemia?
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.
What is the management for a patient presenting with a critical illness?
As per Severe Hypoxaemia:
10-15L/m via NRB, consider BVM if inadequate Vt.
If deteriorates/remains <85%, BVM w/ O2 + consider SGA.
What is the management for a chronically hypoxaemic patient presenting with a critical illness?
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%.
What is the management for a chronically hypoxaemic patient NOT presenting with a critical illness?
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.
List the 6 conditions that receive high flow oxygen, regardless of SPO2.
- Toxic inhalation exposure
- Decompression illness
- Cord prolapse
- Postpartum haemorrhage
- Shoulder dystocia
- Cluster headache
All receive 10-15L/min via NRB
What is the STOP note in this guideline?
High concentration O2 may be harmful in the COPD pt at risk of hypercapnic respiratory failure.
Patients with medically diagnosed pneumothorax but with no intercostal catheter in situ may benefit from..?
High dose oxygen regardless of SPO2.
All patients suspected to have inhaled toxic gases (house fires, CO poisoning) should be given…?
High dose oxygen until arrival at hospital, a pts who show no signs of breathlessness may benefit from this treatment.
