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Fundamentals (RESP 218) > Quiz 2 Prep - flow devices and such > Flashcards

Quiz 2 Prep - flow devices and such Flashcards

1
Q

Define the term high flow oxygen delivery system

A

High flow oxygen systems are capable of meeting all of a patients inspiratory flow demands.

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2
Q

List 2 examples of high flow oxygen delivery systems

A

High flow Cold Neb (misty-ox)

High Flow Nasal Cannula (optiflow)

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3
Q

When would you use a cold nebulizer?

A

Post extubation

Dry throat/nose

Secretions

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4
Q

Which device is the high flow cold neb

A

Green cap

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5
Q

When would you use a high flow neb?

A

Sat less than 86%

Used when FiO2 is greater than 32

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6
Q

Criteria and goals for high flow neb use

A

Goal is to achieve fixed performance (60 or greater)

Flow always set to 40 LPM

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7
Q

Flow through a tube is directly proportional to

A

Radius

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8
Q

What are the goals of oxygen therapy? (3)

A

To correct documented arterial hypoxemia or suspected tissue hypoxia.

To decrease hypoxia

To prevent/minimize the increased cardio-pulmonary work load associated with compensatory mechs related to hypoxia.

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9
Q

What does your body do when you are low on oxygen?

A

Respiratory rate increases
HR increases
Cardiac Output increases
Blood pressure increases

-Pulmonary reflex

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10
Q

General Indications for oxygen therapy (hospital)

A

PaO2 < 60mmHG
O2 Sat < 90 (92 in some cases)

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11
Q

Indications for oxygen therapy in acute situations (hospital)

A

Suspect hypoxemia
severe trauma
MI

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12
Q

Indications for O2 therapy as a short term preventative measure? (hospital)

A

Post anethesia

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13
Q

Precautions of O2 therapy?

A

Chronically elevated PaCO2
High FiO2
absorption atelectasis
Retinopathy of prematurity (ROP)

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14
Q

Absorption atelectasis

A

A loss of lung volume caused by the resorption of air within the alveoli.

Ventilation is blocked = less gas enters
less gas is removed by uptake blood

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15
Q

Retinopathy of prematurity (ROP)

A

eye diseases in babies caused by too much O2

O2 causes abnormal blood vessels to grow in the retina = blindness.

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16
Q

What happens when a patient with chronically elevated PaCO2 is continually given high amounts of O2?

A

They lose their drive to breath

also known as

“Hypoxic drive”

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17
Q

Paraquat poisoning

A

Damage to lining of lungs and exacerbated in the presence of O2.

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18
Q

Laser bronchoscopy

A

Tracheal fire

immediate-acting, palliative, or adjunctive therapy used to relieve central airway obstruction

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19
Q

Which indications for O2 therapy are needed in community?

A

Same as hospital

+

Home care O2
-need proof of severe lung disease

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20
Q

Which systems prevent the most risk of infection
(rank them)

Simple low flow
heated humidity
bypass URT

A

low = Simple low flow
medium = heated humidity + aerosol generators
High = bypass urt

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21
Q

Risks of heated humidity systems

A

-heated humidity is a breeding ground for bacteria
-water needs to be sterile
-hand hygiene all the time

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22
Q

Risks when patients have a bypassed URT

A

-at risk because bypassed their normal line of defence
-ETT
-trach

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23
Q

why must equipment that must be changed or cleaned regularly

A

Ventilator acquire pneumonia (VAP)

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24
Q

What is O2 toxicity?

A

Prolonged exposures to high levels of O2.

Requires prolonged exposure to FiO2 of 0.6
(can very due to injury)

Changes can happen faster under hyper-baric conditions

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25
Q

What increases susceptibility of oxygen toxicity?

A

Advanced age
Catecholamines
Bleomycin
Steroids
Hyperthermia
Hyperthyroidism
Premature birth
Vitamin E
Protein Deficiency

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26
Q

What decreases susceptibility of oxygen toxicity?

A

Youth
Hypothermia
Prior lung damage
Anti-oxidants (glutathione, increased VitC, Vit E)

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27
Q

Exposure to 100% O2: 0-12 hours (early)

A

-Retro-sternal chest pain
cough
dyspnea
emesis,
low energy

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28
Q

Exposure to 100% O2: Late

A

Cyanosis
Frothy sputum
Increased WOB
Respiratory failure

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29
Q

O2 overexposure: once past the 24 hours mark what is expected?

A

decrease in lung compliance
A-a dO2 increases

Decrease in DLco
(diffusing capacity for carbon monoxide )

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30
Q

bTreatments for O2 toxicity?

A

Diuretics and electrolytes for fluid management

Antibiotics and anti-pyretic

Corticosteroids for inflammation

Analgesics for comfort

Bronchodilators for bronchospasm induced dyspnea

Nutritional support to minimize muscle atrophy

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31
Q

Prevention of O2 therapy

A

carful admin (safe upper limit = 250-280mmHg)

Regular ABG/oximetry of patients with high FiO2 (>0.5)

ingestion of antioxidants

intermittent exposure

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32
Q

two basic O2 therapy devices

A

Low flow: gives variable FiO2

High flow: fixed performance

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33
Q

What is fixed performance?

A

everything your patient is breathing in comes from the device and giving a fixed FiO2

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34
Q

Nasal cannula flow?

A

1-6 lpm

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35
Q

What are the advantages of using nasal cannulas?

A

-Wide variety of size
-Very easy to master for disadvantaged patients
-Light weight
-Economical
-Disposable
-Patients tolerate prongs better than mask

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36
Q

What are the disadvantages of using nasal cannulas?

A

-Excessive flows can cause patient discomfort and noise (max. 6LPM)
-Easily dislodged
-Can be problematic if patient has deviated septum, severe nasal mucosal edema, nasal drainage, nasal polyps, facial skin irritation
-Can cause ear irritation
-Does not respond to increased RR or demand

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37
Q

Are nasal cannulas variable or fixed performance?

A

FiO2 is variable and unpredictable

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38
Q

What are the approximate FiO2 at given flow rates with nasal cannula?

A

Every litre is increasing FiO2 about 4%

1 LPM = FiO2 0.24
2 LPM = FiO2 0.28
3 LPM = FiO2 0.32
4 LPM = FiO2 0.36
5 LPM = FiO2 0.40
6-8 LPM = FiO2 0.44-0.50

These may be somewhat optimistic as they require perfect conditions

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39
Q

Simple Mask

A

-Fits over the mouth and nose of the patient with no valves or reservoir bag

-Exhaled gas is vented through holes in the side and spaces around the edge of the mask

-The inside volume of the mask may contain exhaled gas and therefore be considered dead space

-Various sizes, cannot deliver high FiO2s
-May trap vomit and lead to aspiration

40
Q

Why does the minimum flow of a simple mask start at 5LPM?

A

The flow should be sufficient to flush CO2 from the mask

The inside volume of the mask may contain exhaled gas and therefore be considered dead space
-You sort of breathe back the CO2 due to anatomical reservoir

41
Q

what are the aprox FiO2 at given flow rates with simple mask?

A

5-6 LPM = FiO2 0.40
6-7 LPM = FiO2 0.50
7-8 LPM = FiO2 0.60

Higher flows do not seem to raise FiO2 appreciably
Still highly variable under perfect conditions

42
Q

Face tent

A

Very variable performance and don’t really know what FiO2 the patient is getting

-Similar performance to simple O2 mask
-Pouch like design allows patients t get similar flows as mask but no part touches upper part of the face

-May be useful in facial trauma patient or severe claustrophobia

43
Q

Partial Rebreather Mask (PRB)

A

-Very hard to judge FiO2

-Modified non-rebreather mask
-3 disk shaped one-way leaf valves removed
-Reservoir bag attached

-1st third of exhalation should fill the reservoir with high FiO2 gas from patient’s anatomical dead space

-Excess gas vented to atmosphere

-During inhalation, gas from reservoir & gas flowing from O2 source & atmospheric gas all enter the patient’s flow

44
Q

What are the pros and cons of the [PRB]

A

Partial rebreather:

-Higher FiO2 than simple mask
-Minimum flow setting is about 10LPM to disallow complete collapse of reservoir bag on inhalation

-Maximum FiO2 is no higher than 0.6-0.7 depending on patient’s ventilatory pattern

45
Q

Why is entrainment useful?

A

It allows us to deliver precise O2 concentration levels with simple devices by mixing O2 with entrained room air.

46
Q

What is the bases of all entrainment devices (how they basically work)

A

If the sum of the KE and PE must equal, as fluid flows through the restricted area, velocity will increase and therefore lateral pressure will decrease

47
Q

Entrainment: what happens when velocity increases enough to decrease lateral pressure below atmospheric pressure?

A

Creates negative pressure.

when this happens, tubes are often placed distal to the restriction to pull more fluid/gas into the stream flow

48
Q

The amount of fluid/gas entrained depends on?

A

size of entrainment port

size of jet

49
Q

Jet size in relation to entrainment

A

Jet size has an inverse relationship with entrainment.

-smaller the jet, the faster the velocity, the more entrainment

-the bigger the jet, the slower the forward flow, the less entrainment

50
Q

Entrainment ports in relation to entrainment

A

Entrainment ports have a direct relationship with entrainment.

-the bigger the entrainment port, the more entrainment

-the smaller the entrainment port, the less entrainment

51
Q

Things that will increase entrainment

A

smaller jets

bigger entrainment ports

increase in total flow

52
Q

Things that decrease entrainment

A

bigger jets
smaller entrainment ports

decrease in total flow

53
Q

what happens to FiO2 if there is an increase in entrainment

A

increase in entrainment means more room air diluting the O2, therefore FiO2 will decrease.

54
Q

Venturi principle

A

Pressure drop across a restriction can be restored to pre-restriction pressure if there is a gradual dilation of the tube distal to the restriction.

55
Q

Venturi principle : what happens when a restriction is gradually dilated with the addition of jets?

A

The addition of the jet speeds up the flow, causing a pressure drop and creating a sort of vacuum and back pressure pushes against forward flow slowing down entrainment

If there is a build-up of pressure downstream from the entrainment port, there will be a decrease in the amount of fluid or gas entrained.
–> back pressure will slow down the forward pressure, slowing down entrainment which would INCREASE FiO2.

56
Q

Pitot principle

A

Pitot tubes don’t restore the pressure to pre-restriction pressures

Keeps fowrward flow fast, keeps entrainment high, resist affect of back pressure

57
Q

Venturi vs Pitot

A

Venturi
-can restore the pressure to pre-restriction pressure if there is a gradual dilation (≤15°) of the tube distal to the restriction.
-back pressure pushes against forward flow slowing down entrainment

Pitot
-does not restore the pressure to pre-restriction pressure
-keeps pressure low, forward flow fast, entrainment high, resist affect of back pressure

58
Q

What is hyperbaric oxygen therapy [HBOT]

A

HBOT is the use of 100% oxygen at higher atmospheric pressure than is normal to treat some medical problems.

HBOT is used in combination with antibiotics, dressing changes, and surgery to improve healing.

59
Q

What are some possible complications resulting from HBOT?

A

Pulmonary barotrauma
-Damage to equipment with closed gas-filled spaces such as Pacemaker/defibrillator and breast implants
-Need to check pacemaker what it is rated for HBOT

Ear, sinus, or dental barotrauma
-Ear trauma is the most common. Need to ensure the patient does not have ear or sinus problems so they can equalize their ears
-If patient has a crown or dental work filled with gas, it can pop off

60
Q

The role of Boyle’s Law in HBOT

A

It applies HBOT for treatment for accidents/events that result in intravascular and/or tissue gas emboli:

-Decompression Sickness
-Latrogenic Arterial Gas embolism
-Pneumotosis Cystoides Instestinalis (PCI)

61
Q

Rapid Decompression

A

Nitrogen bubbles come out and form in bloodstream - plasma (interrupt blood flow) and can go to your brain
-like having a stroke because interrupting blood flow to the brain

Bubbles interrupt flow to the heart
-like getting an MI

The lungs expand and eventually rupture
-like getting a pneumothorax

62
Q

HBOT and Henry’s law

A

-At constant temperature, more gas is dissolved into a liquid by increasing the pressure of the gas.

-By increasing the pressure in the HBOT chamber, more oxygen can be dissolved in the plasma.

63
Q

HBOT and Boyles law

A

PV = K.
As the pressure increases, the volume of the bubble decreases.

-When your body is under immense pressure, the nitrogen is forced into solution (into blood and tissues).
-As you decompress, nitrogen is forced out of the solution

64
Q

What is the equation for content of arterial oxygen?

A

CaO2 = (Hb x 1.34) x SaO2 + (PaO2 x 0.003)

65
Q

Equation for delivery of O2?

A

DO2 = (CAO2 x 10) x Q

66
Q

Bourdan gauge with thorpe tube: are they back pressure compensated?

A

Yes

67
Q

Hyperbaric Medicine’s Mechanisms of Action

A

Direct Pressure (not an O2 dependent process)
Hyper-oxygenation
Angiogenesis
Anti-microbial
Toxicological Activity (e.g. CO poisoning)
Vasoconstriction
Blunting of ischemia-reperfusion injury (wound care)

68
Q

What changes can be observed in a patients content of arterial oxygen when put in a hyperbaric chamber?

A

Oxygen dissolved in plasma increases significantly

-increases carrying capacity in a healthy individual but almost 40%

69
Q

HBOT and toxicology activity

A

Used as treatment for CO poisoning
-Hypoxemia caused by CO binding to hemoglobin in place of O2 binding
-Co has 210x more affinity than oxygen for Hgb

Brain is most susceptible to CO with cellular injury
-avoid neurological issues by treating with 3 treatments over 24 hrs.

CO Half life (the amount of time it takes to drop the initial CO to half)
-Air breathing: 5-6 hrs
-Atmospheric O2: 75 mins
-HBO at 3ATM: < 30 mins

70
Q

Angiogenesis

A

Sprouting new blood vessels from pre-existing blood vessels (previously damaged by disease or injury)

Treatments for:
-Deficient soft tissue wound healing
-Late radiation tissue injury

71
Q

Antimicrobial Properties

A

Treatments for:
-Clostridial perfingens infections
-Necrotizing soft tissue infections
-Chronic refractory osteomyelitis
-Selected brain abscesses

72
Q

How does HBOT treat compromised/occluded blood flow?

A

Vascular damage = decreased blood flow = decreased oxygen delivery to that area = increased chance of infection

If an area is compromised/occluded, RBC can’t get past but plasma still flows through the damaged vessel.

How HBO treat:
HBOT increases the amount dissolved in plasma and because of new pathways through angiogenesis

73
Q

HBOT: Oxygen and Wound Repair

A

Local Hypoxia
-results from tissue injury

Local Ischemia
-poses a threat to healing and infection

Vascular Endothelial Growth Factor (VEGF)
-promotes closure of chronic hypoxic wounds
-promotes vascular permeability VEGF levels increase significantly with daily HBOT

VEGF is critical to new vessel formation
-its activity only initiates formation of immature vessels
-for functioning vessels, VEGF must work in conjunction with angiopoietins

74
Q

Absolute contraindications to HBOT

A

Untreated Pneumothorax
-will expand and pop

Bronchgenic Cysts

75
Q

Adverse Side Effects of HBOT

A

Decompression Sickness
Tympanic Membrane Damage
Oxygen Toxicity

76
Q

Prohibited Items

A

Cannot take anything in
No lotions, sunscreen, hair preparations, makeup, dentures, synthetic hair, petroleum or alcohol based dressings, velcro, flammable materials, unapproved fabric, etc.

Patient can only enter with what is supplied to them
-100% cotton gown (no pockets)
-one sheet
-Sippie cup with only water

All measure to reduce any chance of spark or static

77
Q

What measures are taken to prevent any chance of static electricity?

A

Humidity in the room is kept at > 50%
The patient wears a grounding bracelet

78
Q

Unapproved (Off Label) Uses for HBOT

A

The following don’t show much improvement with HBOT Multiple Sclerosis
Cerebral Palsy
Autism
Parkinson’s Disease
Fibromyalgia
Concussion
Brain injury
Spinal injuries
Cancer

The following are somewhat more receptive and show improvements
Anti-aging therapy
Long COVID
Sports injuries

79
Q

How do you know if a device is back pressure compensated?

A

A device is back pressure compensated when in the face of back pressure, indicated litre flow remains accurate

Indicated flow = Actual Flow

80
Q

Which device(s) is back pressure compensated?

A

Newer Thorpe tubes
Indicated flow = Actual flow

81
Q

Which device(s) is not back pressure compensated?

A

Bourdon Gauge
Indicated flow > Actual Flow

Older Thorpe tubes & Flow Restrictor
Indicated flow < Actual flow

82
Q

Why is a Bordon type flow meter not back pressure compensated?

A

Because gauge only measure pre-orifice pressure, back pressure reduces flow but flow meter valves doesn’t change.

If you occlude the orifice, it will still display the indicated flow even if it’s actually delivering nothing.

83
Q

How can you indicate if a Thorpe tube is compensated or uncompensated?

A

If the needle valve is before the actual tube, it is uncompensated.

If the needle valve is after the actual tube, it is compensated.

84
Q

What are blenders?

A

A blender is a device that uses approximately 50 PSI gas sources
-typically air and oxygen
-blend together and deliver a specific FiO2

Blenders can produce very high flows and FiO2 ranges of 0.21-0.1

Blenders are typically composed of three systems
Pressure balancing module
-consisting of reducing valves that equalize the inlet pressure of air and oxygen

Proportion module
-to blend the gases in the desired amounts

An audible alarm
-that functions to alert the user to a drop in source pressure of either gas

85
Q

Types of oxygen conservation devices

A

Oxymatic
Oxymizer Pendant
Puritan Bennett CR 50
DeVilbiss

86
Q

Oxygen Conservation Devices

A

Devices to make the tank last longer

2 ways to maximize the contents of the tank:

-Add reservoir - can lower the flow on the tank

-Pulse Dosing - deliver oxygen when they breathe in and not when they exhale

87
Q

Fixed Pressure/Multiple Orifice

A

Barrel Reg
-Pin Index Safety System

88
Q

How is back pressure generated? What affect does back pressure have on the devices?

A

When a gas flow encounters a restriction, back pressure is generated.

Back pressure can alter the litre flow and calibration of the equipment being used it is high enough

89
Q

What are 3 things that can affect Thorpe tubes?

A

Position of the flow meter
-A kinetic device must be in an upright position

Back pressure compensation
-one where indicated flow is the same as actual flow even in the face of back pressure

Condition of the flow tube
-A dirty, damaged, or wet tube will restrict movement of the ball float

90
Q

Variable Orifice/Fixed Pressure

A

Thorpe Tubes
-A vertical tube gradually increasing in diameter

Two opposing forces
-Gravity acting on the float pulling it downward against the force of the gas flow
-Force of molecules striking the float and causing it to rise

As gas flows up, the float is forced higher into the Thorpe tube allowing more gas to flow around it, through annular space.

When the two forces reach an equilibrium, the float will be stationary.

91
Q

Venturi Mask

A

Consists of a jet nozzle, entrainment ports, and a mask

The amount of entrainment depends on:
-Flow rate of the source gas entering the nozzle
-Size of jet nozzle (fixed or interchangeable)
-Size of entrainment ports (fixed or variable)

The higher the velocity of source gas, the higher possible entrainment

Total flow must be higher than patient’s inspiratory demand to ensure no dilution around mask.

Although Pitot type devices can handle some back pressure, all entrainment devices lose accuracy in the face of significant downstream back pressure
-if condensation builds up on the corrugated tubing, the back pressure will decrease the total flow, FiO2 will increase

Can be set to fixed performance
-Only at a low FiO2 (<0.35)

92
Q

What is another way to ensure patient’s FiO2 needs are being met other than inspiratory flow?

A

Inspiratory Volume

Reservoirs (all the below can guarantee a known FiO2)
-Anesthesia Circuits
-Infant isolette
-Oxyhood

93
Q

T-Piece (literal T shaped tube)

A

-Reservoir addition to an open circuit
-Mist coming out the reservoir at end inhalation suggests adequate flow
-Some oxygen that is left in thee reservoir tubing that they didn’t breathe in will be available for the next breath they take

Delivers desired FiO2 for tracheostomy, laryngectomy, ET tubes

94
Q

How and when is a HFCN used?

A

Fixed device at high FiO2 and high flow
-Run at flush (40LPM)
-Start FiO2 at minimum 0.60

SpO2 < 86%
Need a high FiO2
Indications for humidity

95
Q

High Volume Nebulizer (HVN)

A

Can be heated or non heated
-HFCN (MistyOx), HHHHN (Optiflow)

Temperature control can be maintained with either a ‘hot plate’ or an immersion heater
-Desirable if the patient’s normal airway has been bypassed
-Cold neb would be better in decreasing swelling or inflammation in the upper airway

Humidity deficit: @BTPS 43.8mg/L of water is needed to provide the patient sufficient humidity

The connector exiting the neb is a 22mm aerosol tubing connector to allow 2 to 4 meters of large bore tubing to be connected
-More tubing without a heating wire will lead to unacceptable condensation (or rain out) occurring If tubing is full of water and sitting in the corrugated tubing, get rid of it by disconnecting the tubing and disposing
-If it gets in the neb, the neb is contaminated

Patient apparatus can be: Aerosol Mask (intact airway) Face tent (intact airway) Trach cradle (bypassed airway; trach tube, stoma) T-Piece (bypassed airway; trach tube, E tube)

96
Q

How and when is a LVN used?

A

Run at 10LPM
Start FiO2 at 0.30
-can only be fixed FiO2 at <35%

SpO2 ≥ 86%
Don’t need high amounts of oxygen
Indications for humidity

97
Q

Large Volume Nebulizer (LVN) (orange one)

A

Very precise FiO2 available by varying the port size
-FiO2s from 0.21 to 0.95 achievable

Minimum O2 Flow = 10LPM
-If you increase the flow, it won’t reach fixed performance at high FiO2s

Minimum total flow should be 3-6x patient’s resting demand or at least 60LPM to handle peaks

Large bore aerosol tubing (22mm) patient connections allows for humidity (mist) to be delivered

Often used with aerosol mask, T-piece, trach collar (cradle), face tent, etc.

Fundamentals (RESP 218) (4 decks)

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