Intro Respiratory Therapy: Oxygen Delivery Devices

-Treat hypoxemia

-Decrease work of breathing

-reduce myocardial workload

Name 3 indications for oxygen therapy

-PaO2

-SpO2

-SaO2

name 3 ways to assess oxygen levels?

-O2 toxicity

-Oxygen Induced hypoventilation (hypoxic drive)

-Retinopathy of Prematurity

-Absorption atelectasis (nitrogen washout)

name 4 major hazards of oxygen delivery

yes

If a patient is confused, tachypneic, and tachycardic could we suspect hypoxemia?

Oxygen Toxicity

Refers to cellular injury of lung parenchyma & airway epithelium

60%

to prevent O2 toxicity, extended exposure to FiO2 > _________% should be avoided

ARDS

O2 toxicity may lead to...

True

True or False: In oxygen therapy, we aim to use as little oxygen as possible

COPD patients

what patients are at risk of oxygen induced hypoventilation?

PaO2= 55-65, SpO2= 88-92

give the desired PaO2 and SpO2 ranges for COPD

80 mmHg

Retinopathy of Prematurity is caused by PaO2 > _______ mmHg in premature infants

50-80 mmHg

What is the desired PaO2 range for premature infants?

Absorption atelectasis

alveolar collapse due to nitrogen washout is called...

Nitrogen

Absorption atelectasis is caused by reduced ____________ in the lung

It reduces production of surfactant

why does reduced nitrogen in the lung cause atelectasis?

FALSE: Oxygen is NOT a flammable gas but it does support combustion

True or False: Oxygen is flammable

Decreases ciliary movement

How does excessive oxygen affect ciliary activity?

-Low-flow systems

-High-flow systems

-Reservoir systems

Name 3 basic oxygen delivery design systems

Low-flow systems

O2 DEL system with fixed flow rates and provides only a portion of the patient's ventilatory requirements

High-flow systems

O2 DEL system with fixed performance and provides ALL of the patients inspiratory requirements at a specific FiO2, regardless of the flow rate or patients ventilatory pattern

Low-flow systems

which O2 DEL system will have variable results in performance based on the patients inspiratory effort, tidal volume, respiratory rate

Reservoir system

O2 DEL system designed to conserve oxygen

1-6 LPM; 24-44% FiO2

Give the LPM and FiO2 range for nasal cannula

True

True or False: on a nasal cannula, the FiO2 depends on how much room air the patient inhales in addition to the supplied O2

Trantracheal Catheter

device surgically placed in the neck by a physician; clogs easily and must be cleaned with a cleaning rod

5-10 LPM; 40%-60% FiO2

what is the LPM and FiO2 range for a simple mask?

10-15 LPM; 80-100% FiO2

give the LPM and FiO2 range for nonrebreathers

10-15 LPM; 60-80% FiO2

give the LPM and FiO2 range for partial rebreathers

high flow devices

these devices supply oxygen at flows equaling or exceeding the patient's peak inspiratory flow

High-flow systems

O2 DEL system most suitable for patients requiring a precise FiO2 or with a variable minute ventilation

Venturi Mask

a patient has a variable minute ventilation and requires a precise FiO2. Reccomend a specific O2 DEL device.

FALSE: Increasing the flow on a high flow device WILL NOT affect the FiO2

True or False: Increasing the flow on a high flow device WILL increase the FiO2

-Jet Size

-Entrainment Port size

what 2 factors determine the FiO2 on a Venturi Mask?

lower

the larger the air entrainment port, the ______________ (higher, lower) the FiO2

higher

the smaller the air entrainment port, the ______________ (higher, lower) the FiO2

less, higher

the larger the jet size, the ___________ (more/less) air entrained, thus _____________ (higher/lower) FiO2

more, lower

the smaller the jet size, the ___________ (more/less) air entrained, thus _____________ (higher/lower) FiO2

FiO2 would increase (because less air is entrained)

if the air entrainment port became occluded (by the patients hand) how would the FiO2 be affected?

100-X/X-20* (21 if FiO2 is less than 40%)

what is the air to oxygen ratio formula?

high flow nasal cannula

O2 DEL device that provides high FiO2, high relative humidity, and positive pressure (i.e optiflow, airvo)

hypoxemia

supplemental oxygen is indicated when __________ is suspected

lower

the higher the FiO2, the _________ (higher/lower) the air:oxygen ratio

bag-mask device

O2 DEL device that delivers 100% FiO2 often during emergencies

helium

what is the second lightest gas?

heliox

helium mixed with oxygen is called...

lower density thus the gas can pass through obstructions more easily

what is the main benefit of heliox?

brown and green

what color is a heliox cylinder?

80:20, 1.8

70:30, 1.6

give the 2 heliox:oxygen ratios and their correction factors

because heliox is less dense than oxygen

why must we multiply the heliox flow rate by a correction factor?

10 x 1.8= 18 L/min

you're running an 80:20 heliox mixture through an O2 flow meter at 10 L/min. calculate the true flow rate

10 x 1.6= 16 L/min

you're running a 70:30 heliox mixture through an O2 flow meter at 10 L/min. Calculate the true flow rate.

-Nonrebreather

-ET tube

-Trach tube

Heliox mixtures must be delivered through a tightly closed system. Name 3 devices suitable for heliox mixtures.

inhaled nitric oxide

selective pulmonary vasodilator indicated for ARDS and PPHN

FiO2%

what does the X stand for in the air:O2 formula?

blood

fluid that regulates body temperature and maintains the pH of bodily fluids

at least 5 g/dL

how many g/dL of reduced hemoglobin will cause cyanosis?

p50

the point at which 50% of hemoglobin is saturated with oxygen

27 mmHg

what is the approximate p50?

-dissolved in plasma

-attached to hemoglobin

what are the 2 ways oxygen is carried in blood?

1.34 x Hb x SaO2

formula for oxygen bound to hemoglobin

0.003 x PaO2

formula for hemoglobin dissolved in plasma

-hypoxemic hypoxia

-anemic hypoxia

-stagnant (circulatory) hypoxia

-histotoxic hypoxia

name the 4 types of hypoxia

hypoxemic hypoxia

hypoxia caused by lack of O2 in the blood as a result of alveolar hypoventilation, inadequate O2 in inspired air, diffusion defects, V/Q mismatch, and anatomic right to left shunt

Anemic hypoxia

when the bloods capacity to carry O2 is reduced as a result of decreased hemoglobin level or CO poisoning

anemic hypoxia

what kind of hypoxia is CO poisoning?

ABG with co-oximetry

what diagnostic tool should be recommended for suspected CO poisoning?

Stagnant (circulatory) hypoxia

when the O2 content and carrying capacity is normal, but capillary perfusion is diminished as a result of decreased heart rate, decreased cardiac output, shock, or embolism

histotoxic hypoxia

what kind of hypoxia is caused by cyanide/alcohol poisoning?

-cyanide poisoning

-air embolism

name 2 conditions for which hyperbaric oxygen therapy is indicated

-Galvanic O2 analyzers

-Polargraphic O2 analyzers

name the 2 kinds of O2 analyzers

warming, filtering, and humidifying inspired air

what are the 3 functions of the nose?

the carina

at what anatomical point is inspired air 100% saturated with water?

37 C (body temperature)

at the carina, what temperature is inspired air warmed to?

aerosol

suspension of water in a particle form in gas

1-5 microns

what is the ideal particle size range of aerosols?