Week 8- Oxygenation and Ventilation

Question 1

Administer high concentration O2 for pt’s who have….

Answer 1

confirmed/ suspected carbon monoxide/ cyanide toxicity/ noxious gas exposure
upper airway burns
scuba diving related disorders
ongoing cardiopulmonary arrest
complete airway obstruction
sick cell anemia with suspected vaso-occlusive crisis

Question 2

How do we oxygenate a pt with COPD?

Answer 2

titrate oxygen administration
achieve O2 saturation between 88-92 %
Reassess vitals every 10 mins
Increase by increments of 2Lpm above starting level approx every 2-3 mins

Question 3

What is oxygen saturation?

Answer 3

the fraction of o2 saturated hemoglobin relative to the TOTAL hemoglobin in the blood
normal should be 97-100%
SpO2 %

Question 4

What is COPD?

Answer 4

Chronic Obstructive Pulmonary Disease
- blocked airway causes inflammation=chronic bronchitis
- damage to air sacs makes gas exchange DIFFICULT
- smokers, long term chemical exposure etc.
These pt’s are CO2 retainers, we titrate because there is potential to knock out their hypoxic drive

Question 5

What are the 2 types of oxygen tanks?

Answer 5

D tank- carried in the medics bag, holds 425L of O2
M tank- in the ambulance, holds 3450L of O2

Question 6

What is the regulator?

Answer 6

Attached to the top of the cylinder
Reduces and elevated PSI
Attaches to the yolk!
Has a flowmeter to regulate O2 amount to the delivered

Question 7

What is the PISS?

Answer 7

Pin Index Safety System
- ensures you are attached to the o2 tank
- attached directly to the tank
- three pin holes

Question 8

What is the portable flowmeter?

Answer 8

Controls the amount of oxygen being delivered
Connected to the regulator

Question 9

What is the safe residual pressure according to the MOH EMS Standards?

Answer 9

500 psi

Question 10

How do you calculate oxygen tank life?

Answer 10

(tank pressure in psi - safe residual) x factor ÷ Lpm
= time till cylinder is empty

Question 11

What is the standard tank conversion factor for an M cylinder?

Answer 11

1.56

Question 12

What is the standard tank conversion factor for an D cylinder?

Answer 12

0.16

Question 13

When do we change tanks?

Answer 13

500psi left

Question 14

Who are the supplemental devices used for?

Answer 14

Pt’s with spontaneous respirations

Question 15

Who are ventilation devices used for?

Answer 15

Pt’s who cannot breathe on their own
VENTILATION
- BVM
- CPAP

Question 16

What is FiO2?

Answer 16

Fraction of INSPIRED oxygen

Question 17

What is the breathing room air FiO2?

Answer 17

~21%

Question 18

What is the formula for FiO2 calculation?

Answer 18

(L/min x 4 ) + 21 = fraction of inspired o2

Question 19

What influences FiO2?

Answer 19

Breathing rate and depth

Question 20

What are the low flow devices?

Answer 20

Cannulas
Simple face masks (ped)
Nebulizer mask

Question 21

What is the low concentration %?

Answer 21

21%-50%

Question 22

When do you choose a Nasal Cannula?

Answer 22

pt requires low concentration O2
NO dyspnea
NOT apenic (resp. arrest)
Able to breath through nose
Pt that cannot keep face mask on (ex. vomitting)
Pt with COPD and exhibiting complaints of SOB w no altered LOA
Often a more stable pt

Question 23

What does a nasal cannula run at?

Answer 23

2-6 Lpm

Question 24

When to use Simple Oxygen mask?

Answer 24

minor/mild complaints
lower concentration O2
runs at 6-10Lpm
not common, often in pediatric size

Question 25

When to use the Nebulizer mask and what do you run it at?

Answer 25

needed to deliver medication (ventolin) called nebulized treatment runs at 4-6Lpm

Question 26

What are the high flow devices?

Answer 26

NRB BVM FLOW MAX CPAP

Question 27

What is the % for high concentration O2 devices?

Answer 27

50-100%

Question 28

When to chose a Non Rebreather?

Answer 28

pt requires HIGH concentration O2 pt can maintain their own airway pt with c/o SOB, evidence of resp. distress pt with low SP02

Question 29

What does an NRB run at?

Answer 29

12-15Lpm 90-100 o2 delivery

Question 30

When to chose a FLOMAX?

Answer 30

Covid Resp illness Fever Anything infectious **need to administer medication (attaches to nebulizer cup)

Question 31

What is a Flowmax run at?

Answer 31

12-15Lpm

Question 32

Respiration Is the process of breathing that involves ......

Answer 32

both ventilation and oxygenation

Question 33

Ventilation is the molecular exchange of..... and involves movement of air.....

Answer 33

gases in the body in and out of the lungs

Question 34

Oxygenation is the molecular absorbance of oxygen that involves the...

Answer 34

diffusion of oxygen molecules from environmental air into the blood stream

Question 35

Bag Valve Mask: what does it run at?

Answer 35

runs at 12-15Lpm 100% O2

Question 36

How to BVM:

Answer 36

create a tight SEAL (C & E) ventilate at 10-12 breaths/min timing: squeeze BVM during inhalation phase Communication with pt

Question 37

When to use the BVM:

Answer 37

Respiratory rate TOO low: breathing lower than 8 VENTILATE or < 12 bpm and hypo-perfusion is present Respiratory rate TOO high: > 28 bpm

Question 38

How to manage airway:

Answer 38

- OPEN using manual airway techniques like head tilt-chin lift / modified jaw thrust OR to get a better opening use an OPA or NPA - CLEAR the airway using suctioning devices

Question 39

When do we insert an OPA?

Answer 39

No gag reflex (eyelash test) Unconscious Decreased LOC Hypoventilation

Question 40

When do we insert an NPA?

Answer 40

Pt with GAG reflex Contraindications: basul skull # Trismus Pt has to be over 5 yrs old LUB it up!

Question 41

When preparing to insert BLS airway devices...

Answer 41

1. Open airway (assess if suctioning needed) 2. Measure device needed 3. Insert with caution

Question 42

How to measure an OPA?

Answer 42

Corner of the to the jaw