Week 8- Oxygenation & Ventilation Flashcards
1
Q
Provincial equipment standards
pg 76-86
pg 21-28
A
2
Q
What is the Oxygen Therapy Standard BLS?
A
- Administer oxygen therapy using an oxygen delivery system and flow rate to attempt to maintain a pt’s oxygen saturation between 92-96%, as measured by Sp02, unless specified otherwise in Standards
- Continuously administer high concentration oxygen for patient’s who have,
a. confirmed or suspected carbon monoxide or cyanide toxicity or noxious gas exposure
b. Upper airway burns
c. Scuba-diving related disorders
d. Ongoing cardiopulmonary arrest
e. Complete airway obstruction, and/or
f. Sickle cell anemia with suspected vaso-occlusive crisis - If pulse oximetry equipment is not functioning or not providing an interpretable wave form, administer high concentration oxygen to all patients specified in paragraph 2 above, as well as those with critical findings, which include
a. Age-specific hypotension
b. Respiratory distress
c. Cyanosis, ashen color, pallor
d. Altered LOC, and/or
e. Abnormal pregnancy or labor
3
Q
When do we titrate/ give a COPD oxygen?
A
- If a patient with COPD has increased dyspnea, a decreased LOC, an altered mental status, and/or suffered major trauma
4
Q
What is the oxygen therapy for COPD patients?
A
- Titrate oxygen administration to achieve an oxygen saturation between 88-92%. If pulse oximetry equipment is not functioning, adminster oxygen by nasal cannula with oxygen flow at 2L/min above the pt’s home oxygen levels, or 2L/min if patient is not on home oxygen
- Re-assess the vital signs approx every 10 mins
- Maintain oxygen flow rate at that level, if the pt’s status improves
- Increase oxygen by increments of 2L/min above starting level approx every 2-3 mins if the pt’s status deteriorates or the pt indicated they feel worse; and
- Be prepared to ventilate
5
Q
What is COPD and who get its?
A
- 90% are smokers
- Long term chemical exposure
- Disease, deficiencies, abnormalities
- These pt’s are decribed as C02 retainers
- We titrate 02 with these pt’s because of the potential to knock out their hypoxic drive
6
Q
Oxygen Tanks
A
- Are color coded- green & white/ or have a green stripe on top
- Larger tanks are stored with a protective cap
- Tanks are under pressure and should not be dropped
7
Q
How do we carry oxygen in the firld?
A
- “D” tank
- Approx 4” diameter approx 16.5” tall
- Hold approx 425 L of compressed oxygen
- Filled under pressure of 2000 to 2200 psi
- Carried in the medics “oxygen bag”
8
Q
How do we carry oxygen in the ambulance?
A
- “M” tank
- Approx 8” diameter approx 36” tall
- Hold approx 3450 L of compressed oxygen
- Is filled under pressure of 2000 to 2200 psi
- Carried in the ambulance, is not portable
- Used with pt’s in the ambulance
9
Q
What is the regulator?
A
- Attaches to the top of the oxygen cylinders
- Reduces the 2200 psi pressure to approx. 50 psi, and eventually 30 psi for safe pressure delivery for pt’s
Consists of “input connection” system that confirms to the international standards organization for oxygen known as the PISS - Attach to tank using a “yolk” assembly system & have a flowmeter attachment to regulate o2 amount to be delivered & attachment point
10
Q
What is the Pin Index Safety System?
A
- Yoke
- Is attached to the regulator pressure gauge
- Attaches directly to the tank
- PISS ensures you are attached to 02 tank only
- Often includes attached flowmeter
11
Q
Portable Flow Meter
A
- Control the amount of oxygen that is delivered to the pt. “Litre Flow”
- Is often connected directly to the pressure regulator in oxygen bags carried by medics
12
Q
When to change the oxygen tank?
A
- Safe residual pressure- Ontario MOH EMS standards is usually “500 psi” (minimum SRP is 200 psi- as indicated in most textbooks)
- M tanks changed at 200 psi
- D tanks changed at 500 psi
- D cylinder- 0.16
- My cylinder- 1.56
13
Q
How do you calculate oxygen tank life?
A
Tank pressure (in psi) - safe residual x factor / L/min
= time until cylinder empty
Ex. Start with a full D tank at 12 lpm how long until empty?
2000 psi- 500 psi x 0.16/ 12 lpm
= 1500 x 0.16/ 12 lpm= 240/ 12 lpm= 20 mins
14
Q
What does Fi02 stand for?
A
Fraction of inspired oxygen
15
Q
What is the pt’s Fi02 when we give 02?
A
Formula: Fi02= (L/min x 4%) + 21%
- when adding oxygen masks
- add approx 3-4% for reach 1 liter of oxygen
- Often 4% is used as the calculation number
16
Q
Calculating Fi02
A
Ex. Nasal cannula- running at 6 lpm
Fi02= (6lpm x 4%) + 21% (atmospheric oxygen)=
24 + 21= ~45% oxygen concentration
17
Q
What influences Fi02?
A
- Breathing rate
- Breathing depth (tidal volume)
- Pathology- 02 transported in 2 ways in body (98% in hemoglobin (in RBC) & 2% in plasma
18
Q
What are issues that can affect transport of 02?
A
- Is your pt suffering from blood loss? Decrease in Cardiac output & decrease in blood?
- Is your pt suffering from anemia- decrease in RBCs or hemoglobin?
19
Q
Low flow devices
A
- Low flow devices add oxygen to pt’s current inspiratory flow:
- These devices are lower than the pt’s own inspiratory demands
- Devices include cannulas, simple face masks, nebulizer masks
- Low concentration 21 to 50%
20
Q
Nasal Cannula
A
- Low concentration device and attaches to the nose
- Note for pt’s in respiratory distress/ or apnea/ or require high concentrations of 02
- Max 6 lpm= 44-45% oxygen concentration
- Concentration reduced as pt. continues to breath thru mouth
21
Q
When should you use a nasal cannula?
A
- Pt’s requiring low concentration oxygen
- No dyspnea (SOB)
- Not apenic (resp arrest)
- Able to breath thru nose
- Pt who can keep face mask on- i.e. vomiting
- Pt with COPD & exhibiting mild to moderate complaints with no altered LOA/ no cyanosis
- ## Often more “stable” pt
22
Q
What does simple oxygen run at?
A
- Run at 2-6 lpm
23
Q
Simple Oxygen Mask
A
- Have no resrvoir
- Minor/ mild pt complaints
- Lower oxygen concentrations- 6-10 lpm= 40-60%
- Not commonly used in EMS- often pediatric size
24
Q
Nebulizer Mask
A
- Allow medic to deliver medication with oxygen- i.e. ventolin
- Called a “nebulizer Tx” runs at 4-6 lpm
25
Q
What are the high flow devices?
A
- NRB (non rebreather)
- BVM (bag valve mask)
- Pocket mask
- CPAP
26
Q
What do we run a non-rebreather mask at?
A
- 12-15 lpm
- 90-100% 02 delivery
27
Q
Non-rebreather
A
- Mask allows the pt to inhale from reservoir bag but not exhale back into it
28
Q
When to choose the NRB?
A
- Pt requiring high concentration oxygen
- Pt’s that can maintain their own airway
- Pt’s with % SOB and evidence of Resp distress
- Refer to BLS
29
Q
What do we run a filtered 02 mask?
A
- 10-15 lpm
30
Q
Filtered 02 Mask
A
- FL02 Max is a low flow, high concentration mask 10-15 lpm
- Medic can use for any pt that is positive for resp infection/ fever
- Can attach nebulizer cup to this mask
- Exhalation is filtered through submicron, hydrophobic 3M filter to protect health care workers
31
Q
When to choose filtered 02 mask flowmax?
A
- Covid +
- Resp illness
- Fever
32
Q
What is Sp02 an indication of?
A
- it is an indication of oxygenation not ventilation
33
Q
Respiration
A
- process of breathing that involves both ventilation and oxygenation
34
Q
Ventilation
A
- molecular exchange of gases in the body and involves the movement of air in and out of the lungs
35
Q
Oxygenation
A
- molecular absorbance of oxygen that involves diffusion of oxygen molecules from environmental air into the bloodstream
36
Q
CPAP (continuous positive airway pressure)
A
- CPAP is a machine that uses mild air pressure to keep breathing airways open
- It is a high flow 02 delivery
- It is commonly used in:
- COPD and Pulmonary Edema pt’s
- The pt must be breathing
- The pt must be able to maintain
37
Q
What do we run bag valve mask at?
A
- 15 lpm
38
Q
Bag Valve Mask
A
- Provides high concentration 02
- Provides positive pressure ventilation
- Adult BVM holds 1600 mls
- Ped BVM hold 500 mls
- Multiple mas options
- Delivers 100% 02
39
Q
When do we use a BVM?
A
- Resp rate is too low:
- often <8 bpm or <12 bpm if signs of hypotension present- i.e. cyanosis/ decreased LOA/ poor effort & or tidal volumes
- Resp rate is too high
- often >28 bpm associated with fatigue & poor oxygenation- i.e. pt getting tired or head injury
40
Q
What is the goal of a BVM?
A
- Increase ventilation rate of pt to 10-12 bpm
- Increase ventilation depth allowing pt to breath accordingly & you supplement every 3-4th breath by squeezing the BVM
- Time- squeeze BVM during inhalation phase
- Communicate with conscious pt
41
Q
What are the manual Airway techniques?
A
- Head tilt chin lift
- Modified Jaw thrust
42
Q
How do you clear the airway?
A
- suctioning devices
43
Q
What are the manual airway devices?
A
- OPA
- NPA
- Supraglottic airway devices
- Intubation- oral & nasal
44
Q
What is head tilt chin lift?
A
- hyperextend the neck
- Lift the chin & displace the tongue
45
Q
What is the modified jaw thrust?
A
- no hyperextension of neck
- medic grasps the angles of the pt. lower jaw & lifts without tilting the head
- During this maneuver the pt’s head is stabilized while you displace the mandible forward
46
Q
OPA
A
- come in various sizes
- designed to hold tongue off posterior wall of pharynx
- made from disposable plastic/ color coded by size
47
Q
How do we insert an adult OPA?
A
- open airway
- measure airway- corner of mouth to angle of jaw
- insert at 90 degrees- gets airway behind the tongue
- Rotate once pass the tongue
48
Q
How ton insert an peds OPA?
A
- Open airway
- Measure airway- corner of mouth to angle of jaw
- Insert directly without rotation
- can use tongue depressor to hold tongue if available or use thumb
49
Q
What if you arrive to a scene an OPA is already inserted?
A
- Reassess the pt and if their improving leave it in but if it’s not helping than take it out
50
Q
Why would we use an NPA?
A
- Gag reflex in place- pt is responsive but not alert enough to control their own airway
- No gag reflex & pt is unresponsive, can’t control their own airway & for some reason can’t accept an OPA
- Maybe facial/ mouth trauma
51
Q
NPA
A
- Various sizes
- Pt often has to be over 5 years of age
- Require lubricant for insertion into nostril
52
Q
How to do we prepare to insert an NPA?
A
- Open airway- assess for lash reflex
- Measure airway: from nostril to tip of ear lobe- follow natural curve of airway
- Lubricate with water- soluble lubricant- this will ease insertion
53
Q
How do we insert a NPA?
A
- Try right nostril first
- Bevel on septum
- Ensure nose is up & nostril is open
- any resistance try other nostril
- Left nostril, turn so bevel is on septum
- Allow NPA to turn 180 degrees so sitting naturally in airway
