Oxygen Therapy & Airway Mgmt

Question 1

Mild- moderate Hypoxaemia.

Answer 1

SpO2 = 85-91%.

Titrate O2 flow to SpO2 of 92-96%.

Action:
   - Initial 2-6 L/min via 
     nasal cannulae.
   - Consider simple 
     face mask 5-10 
     L/min.

Question 2

Severe Hypoxaemia

Answer 2

SpO2 = <85%
    or
Critical Illness:
   - Cardiac arrest or 
     resus.
   - Major trauma/ head 
     injury.
   - Shock.
   - Severe sepsis.
   - Anaphylaxis.
   - Status Epilepticus.
   - Ketamine Sedation.

Action:
   - Initial non- 
     rebreather mask 10- 
     15 L/min.
   - If inadequate VT, 
     consider BVM w/ 
     100% O2.
   - Once 
     haemodynamically 
     stable & reliable 
     reading, titrate   
     SpO2 to 92-96%.
   - If deterirates or 
     SpO2 remains <8 
     85%; 
       ~ BVM &amp; vent w/ 
         100% O2.
       ~ Consider SGA.

Question 3

Chronic Hypoxamia

Answer 3

• COPD.
• Neuromuscular
  Disorders.
• Cystic Fibrosis.
• Severe
  Kyphoscoliosis.
• Obesity.

STOP:
   - High-concentration 
     O2 may be harmful 
     to COPD pt @ risk of 
     hypercapnic resp 
     failure.

Action:
   - Titrate O2 flow to 
      88-92%
       ~ No critical illness 
          then initial 2-6 
          L/min via nasal 
          cannulae.
       ~ Consider simple 
          face mask.
   - If pt deteriorates or 
     SpO2 remains < 85%
       ~ Rx as per Severe 
          Hypoxaemia.

Question 4

Regardless of SpO2

Answer 4

* Toxic inhalation 
   exposure.
* Decompression 
   illness.
* Cord prolapse.
* Postpartum 
   haemorrhage.
* Shoulder dystocia.
* Cluster headache.

Action:
- O2 via non-
rebreather mask 10-
15 L/min.

Question 5

Special Circumstances

Answer 5

O2 therapy can be harmful in Paraquat & Bleomycin poisoning . The maintenance of prophylactic hypoxaemia in these patients (85-88%) is recommended.

Question 6

Supra-Glottic Airway (SGA)

Status

Answer 6

- Unconscious w/o gag 
  reflex.
- Ineffective VT w/ BVM 
  & basic airway mgmt..
- > 10 mins assisted VT.
- Unable to intubate.

Question 7

SGA Contra’s

Answer 7

- Intact gag reflex or 
  resistance to 
  insertion.
- Strong jaw tone or 
  trismus.
- Suspected epiglottitis 
  or upper airway 
  obstruction.

Question 8

SGA Precautions

Answer 8

- Inability to prepare 
  the pt in sniffing 
  position.
- Pt's who require high 
  airway pressures.
- Paed pt's who may 
  have enlarged 
  tonsils.
- Vomit in airway,

Question 9

SGA Side Effect

Answer 9

Correct placement does not prevent passive regurgitation or gastric distention.

Question 10

i-Gel size

Answer 10

1. 0 = 2-5kg N/A
2. 5 = 5-12kg 10
3. 0 = 10-25kg 12
4. 5 = 35-35kg 12
5. 0 = 30-60kg 12
6. 0 = 50-90kg 12
7. 0 = 90+kg 14