oxygen therapy Flashcards
Who does the oxygen therapy guideline apply to?
anyone above the age of 12
define adequate oxygen levels according to spo2?
Spo2 > 92% RA
Spo2 range for Mild- mod hypoxaemia
85-91%
Management of mild-mod hypoxaemia
Nasal cannula 2-6l/min
hudson mask 5-10l/min
Spo2 range for severe hypoxaemia
<85% or critical illness
outline the critical illness
- cardiac arrest/resus
- major trauma/head injury
- anaphylaxis
- shock
- status epilepticus (seizure)
- severe sepsis
- ketamine sedation
Management of severe hypoxaemia
Non-rebreather 10-15l/min
if inadequate Tidal volume ventilate BVM
once haemodynamically stable titrate to 92-96%
if deteriorate continue BVM 100% O2, consider SGA
list of chronic hypoxaemia
- COPD
- Obesity
- Cystic fibrosis
- bronchiectasis
- Neuromuscular disorder
- severe kyphoscoliosis
Management of chronic hypoxaemia
titrate to 88-92%
Nasal prongs 2-6l/min
Hudson mask 5-10l/min
if deteriorates treat as severe
regardless of SPO2
- Toxic gases
- Decompression illness
- Cord prolapse
- Post partum haemorrhage
- Shoulder dystocia
- Cluster headache
Mx with Non-rebreather 10-15l/min
What conditions are not routinely treated with oxygen?
WHY???
- Acute coronary syndrome
- stroke
- arrhythmia
Why? this pts may c/o feeling SOB, the cause of SOB is a reduction in blood flow to tissues, due to obstruction (clot), leading to ischaemia of tissues
what do you do if you are unable to obtain SPO2?
if pt appears hypoxic or SOB admin oxygen 2-6l/min via nasal prongs, or 5-10l/min via hudson mask
SPO2 can be unreliable in pt with?
- nail polish
- hypotension
- cold hands
- peripheral vascular disease
- anaemia
- peripherally shutdown
- severe asthma
- carbon dioxide poisoning
Spo2 goal for paraquat & bleomycin poisoning?
85-88%
why do we aim for 85-88% Spo2 in paraquat/bleomycin poisoning?
these substances lead to pulmonary damage by triggering the release of oxygen free radicals which can lead to lung damage, causing pulmonary oedema/fibrosis
what is bleomycin?
bleomycin is a type of antibiotic used in the treatment of cancers such as non-Hodgkin’s/Hodgkin lymphoma, testicular and cervical cancer. Bleomycin works by inhibiting DNA synthesis, stopping or slowing the growth of cancer cells
what is paraquat?
paraquat is a form of herbicide, different to organophosphates.
benefit of upright position in pts
- aids in inspiration/expiration
- gas exchange improves
- gravity exerts pressure on the lungs, compressing the base of the lungs against the diaphragm, increasing surface area & exposing more alveoli for gas exchange. alveoli in bases are smaller, more numerous, meaning less o2 required for gas exchange.
what is kyphoscoliosis?
Kyphoscoliosis is a condition that causes the abnormal curvature of the thoracic lumbar spine. this condition can lead to the chest wall malformation. this impairs mechanics of respiration, leading to poor chest wall compliance, causing hypoventilation, hypercapnia and respiratory failure. impairs muscles at nerve junctions impairing respiration
what is bronchiectasis?
Bronchiectasis is a condition in which the lungs/bronchioles become damaged causing airway to permanently widen & impairs mucus clearance, leading to infection and increased dead space.
What is capnography?
Capnography is the numerical measurement & graphical display of CO2 through respiratory cycle.
ETCO2 – is the measurement of Co2 in the airway at the end of each breath
normal ETCO2 range
35-45mmHg
arterial 38-45mmHg
what happens to ETCO2 when you get rosc
spike due to restoration of circulation (restores co2)
what happens to ETCO when patient arrests
fall or drop, due to loss of circulation
What is the purpose of PEEP?
The benefit of PEEP is to increase the functional residual capacity and reduce pulmonary compliance.
Meaning increases pressure in the lungs at the end of expiration, reducing the stretch of the lungs, decreasing the lung volume, improving gas exchange
What does PEEP stand for?
Positive end expiratory pressure
What is the benefit of elastic recoild in the lungs?
Helps return lungs to resting state and enables passive exhalation. Assists in gas exchange
What does work of breathing refer to?
WoB refers to the effort required to move air throughout the conducting airways and the ease of lung compliance
What is shunting?
Refers to deoxygenated blood that does not participate in gas exchange
Deadspace refers to
An area of no gas exchange
Affinity hypoxia is
Hypoxia as a result of failure of haemoglobin to release oxygen to tissues
Anaemic hypoxia is
Hypoxia that is due to reduce oxygen carrying capacity of blood as a result of decrease in haemoglobin or alteration of haemoglobin
Historic hypoxia is
Impair utilisation of oxygen by tissues
Hypoxemic hypoxia is
A lack of oxygen reaching the blood, for example high altitude
Stagnant hypoxia is
Failure to transport sufficient oxygen because of inadequate blood flow
