Resp 2040 Chapters 13-14

Only chapter 13 so far Ill finish it tomorrow morning

How do you distinguish flammable and inflammable gases?

From Slide: Flammable and inflammable can be used interchangeably; flammable gases require ignition, while the slide describes inflammable gases as capable of combustion without an ignition source.

In simple words: Both terms describe gases that can burn. The slide distinguishes whether an ignition source is needed.

Slide 3

What are the three medical gas flammability classifications?

From Slide: All medical gases can be classified as flammable, inflammable, or nonflammable.

In Simple words: Medical gases are grouped by whether they can burn or not.

What is a nonflammable gas, and what are four examples?

From Slide: Nonflammable gases do not burn. Examples: nitrogen, oxygen, carbon dioxide, helium.

In simple words: These gases cannot catch fire themselves, including oxygen.

Slide 4

What does it mean that medical gases are dry?

From slide: Medical gases are dry: no water vapor is present. Humidity is sometimes added.

In Simple Words: Medical gas starts without moisture; water vapor may be added for patients.

Slide 6

How does oxygen and air support life?

From Slide: Oxygen and air support metabolic production of energy in carbon-based organisms.

In simple words: Our cells need oxygen from air to make energy.

Slide 6

How is compressed air used to adjust delivered oxygen?

From Slide: Compressed air dilutes 100 percent O2 to provide O2 levels between 22% and 99%; ventilators use air and O2 hoses and a blender.

In simple words: A ventilator mixes air with pure oxygen to set the desired oxygen percentage.

Slide 8

When is compressed air used to power breathing devices?

From Slide: Compressed air is used as a driving pressure for breathing devices when patients do not require supplemental O2.

In simple words: Air can power respiratory equipment without wasting pure oxygen.

Slide 8

How do piped medical air systems maintain 50 psi?

From Slide: Large compressors supply piped air; a pressure-sensitive switch turns the compressor on/off to maintain 50 psi line pressure.

In simple words: Hospital compressors automatically keep the medical air supply near 50 psi.

Slide 9

How do portable compressors prepare air for home use?

From Slide: Small portable compressors are available for home use; condensers and filters remove dust and water.

In simple words: Home compressors provide clean, dry air; they keep dust out of the machine.

Slide 9

Why does oxygen increase fire risk if it is nonflammable?

From Slide: Oxygen is colorless, transparent, odorless, tasteless, and nonflammable; it vigorously accelerates and supports combustion.

In simple words: Oxygen does not burn, but makes other materials burn faster and hotter.

Slide 10

At what temperature does oxygen liquefy at atmospheric pressure?

From Slide: Gaseous O2 can be liquefied at -182.9 C, its boiling point: liquid O2 remains liquid below its boiling point.

Simple words: Cool oxygen below -182.9 C to keep it liquid

Ch 13 Slide 11

How does pressure and temperature affect liquid oxygen?

From Slide: O2 can liquefy under sufficient pressure at -118.6 C; liquid O2 has a pale-blue color.

In simple words: Pressure and cold can turn oxygen into a pale-blue liquid.

Ch 13 Slide 11

What are the four methods of oxygen production?

From Slide: Photosynthesis; electrolysis of water; fractional distillation of air; molecular filtration.

In simple words: Plants make oxygen; electricity splits water; distillation separates liquefied air; filters remove nitrogen.

Ch 13 Slide 12

How does photosynthesis and electrolysis produce oxygen?

From Slide: Photosynthesis is the main source and regulator of atmospheric O2/ electrolysis separates H2O into H and O2 using electricity and is impractical commercially.

In simple words: Plants naturally replenish oxygen. Electric current can split water, but it is not practical for large-scale oxygen production.

ch 13 slide 12

Which method produces bulk O2 and home-concentrator O2?

From Slide: Fractional distillation liquefies, filters, dries, pressurizes, and cools air to mass-produce O2; molecular filtration removes N2 from compressed room air in home care.

ch 13 slide 12

How does fractional distillation separate nitrogen from oxygen?

N2 and O2 have different boiling points; N2 evaporates, O2 collects at the tank bottom, and distillation continues until liquid is 99% O2.

In Simple Words: Nitrogen boils off first, leaving highly concentrated liquid oxygen.

ch 13 slide 13

What role does crystallized zeolite play in O2 concentrators?

From Slide: Home O2 concentrators use molecular filtration; crystallized zeolite filters nitrogen from compressed room air.

In Simple words:

Zeolite traps nitrogen so oxygen-rich gas can be delivered.

ch 13 slide 14

What flow rate and oxygen concentration do most home concentrators provide?

From Slide: Most concentrators run 1-5 LPM and deliver FiO2 of about 95-98%

In Simple words: Typical output is 1-5 liters per minute of roughly 95-98% oxygen.

ch 13 slide 14

What maintenance and backup precautions do home O2 concentrators need?

From Slide: Check routinely with an O2 analyzer and flow-measuring device; patients need a plan for power failure and spare O2 cylnders.

ch 13 slide 14

What are the combustion and metabolic properties of CO2?

From Slide: CO2 is nonflammable and does not support combustion or animal life/ it is a by-product of metabolism and burning carbonaceous fuels.

In simple words: CO2 will not burn or support breathing; bodies and burning fuels produce it.

ch 13 slide 15

Is pure CO2 therapeutic, and what are its other uses?

From slide: Pure CO2 is not used therapeutically; it can be used in carbonated drinks, fire extinguishers, or refrigerators.

In simple words: Pure CO2 is used in products and equipment, not as a breathing treatment.

ch 13 slide 15

What properties makes helium an important medical gas?

From Slide : Helium is rare, nonflammable, and the second lightest element; it is inert and does not cross the alveolar-capillary membrane.

In simple words: Helium is very light and does not readily move from alveoli into blood.

Why is helium considered a limited resource?

From Slide: Helium cannot be manufactured; its fixed quantity on Earth has been identified as a future critical shortage.

In simple words: Helium is a limited natural resource that may become scarce.

ch 13 slide 18

What are the two Heliox mixtures and the minimum O2 content?

From Slide: Heliox is helium mixed with oxygen; therapeutic mixtures are 70/30 or 80/20 He/O2, with at least 20 % oxygen.

ch 13 slide 19

When would we use heliox?

From Slide: Because of its light weight, heliox relieves work of breathing in severe bronchospasm (asthma) or upper airway obstruction.

IN simple words: Heliox helps air move through narrowed airways so breathing takes less effort.

ch 13 slide 19

How is nitric oxide (NO) characterized?

From Slide: Nitric oxide, or nitrogen monoxide, is nonflammable, supports combustion, and is not life-supporting; do not confuse with nitrous oxide.

In simple words: NO is a different gas from nitrous oxide; it cannot support breathing by itself.

ch 13 slide 20

What is the clinical purpose of inhaled nitric oxide?

From Slide: NO is used for selective pulmonary vasodilation, usually in neonates; it may be used off-label in adults.

In simple words: Inhaled NO relaxes blood vessels in the lungs, especially in newborn care.

ch 13 slide 20

What are the half-life and hemoglobin-related properties of NO?

From Slide: NO is highly diffusible and lipid-soluble, has a half-life of 3-50 seconds, and has a high affinity for hemoglobin.

In simple words: NO spreads quickly, acts briefly, and interacts strongly with hemoglobin.

ch 13 slide 20

How are medical gases stored in cylinders?

From slide: Steel or aluminum cylinders store and transport medical gases; some gases are stored as liquids or gases, and CO2 may liquefy under cylinder pressure.

In simple words: Gas cylinders come in different sizes; some contain compressed gas, and others contain liquid.

ch 13 slide 21

How do you calculate gas cylinder duration?

Slide: (tank pressure x tank factor) / flow rate

Simple: Multiply psi by the cylinder factor, then divide by L/min to get minutes.

ch 13 slide 4

How is remaining liquefied gas determined?

Slide: Cylinder weight is used because the gauge shows constant pressure.

Simple: Weigh a liquid-gas cylinder; its pressure gauge cannot show how much remains.

ch 13 slide 4

What does a cylinder conversion factor do?

Slide: Converts pressure reading (psi) to volume remaining (L).

Simple: It tells you how many liters of gas correspond to the cylinder pressure.

ch 13 slide 5

What are the O2 conversion factors for E and H/K cylinders?

Slide: E: 0.28, H or K: 3.14

Simple: Use 0.28 for E tanks and 3.14 for large H/K oxygen tanks.

ch 13 slide 5

What measures support safe medical gas cylinder use?

Slide: CGA guidelines, color-coding, markings, testing, standardized valves, indexing, and regulated filling.

Simple: Use clear identification, regular checks, correct connections, and safe handling rules.

ch 13 slide 9

How should medical gas cylinders be stored?

Slide: Cool, dry, ventilated, fire-resistant, secured storage; protected from weather and unauthorized access.

Simple: Keep cylinders in a safe, ventilated, locked area away from heat and hazards.

ch 13 slide 10

How should full and empty cylinders be organized?

Slide: Provide segregated, clearly labeled locations for full and empty cylinders.

Simple: Separate full tanks from empty ones so they cannot be mixed up.

ch 13 slide 10

How should large and small cylinders be secured?

Slide: Large cylinders upright with protective caps and restraints; small cylinders secured in racks, holders, or carts.

Simple: Keep big tanks upright and chained; secure smaller tanks so they cannot roll or fall.

ch 13 slide 10

How should E and H/K tanks be transported?

Slide: E tank: pull behind; H/K tank: push in front with chain in position.

Simple: Pull a small E-cylinder cart; push a secured large-cylinder cart ahead of you.

ch 13 slide 11

What safety precautions apply when handling cylinders?

Slide: Use lifting precautions; the regulator is not a handle.

Simple: Lift carefully and never carry a tank by its regulator.

ch 13 slide 11

How does a direct-acting cylinder valve work?

Slide: Turning the handle moves the stem and seat up or down, allowing gas through the port.

Simple: Turning the handle opens or closes the path for gas to escape.

What is the purpose of a pressure-relief device?

Slide: Controlled release of excess pressure; typically opens at 1.5 x normal filling pressure.

Simple: It vents dangerously high pressure to help prevent cylinder rupture.

ch 13 slide 17

What are the three types of safety relief valves?

Slide: Spring-loaded safety valve, frangible disc, and fusible plug.

ch 13 slide 18

How does a spring-loaded safety valve work?

Slide: When pressure exceeds the spring tension, gas is released through vents.

Simple: High pressure pushes against the spring, venting gas.

ch 13 slide 18

How do frangible discs and fusible plugs work?

Slide: Frangible disc breaks at excess pressure; fusible plug melts at excess temperature.

Simple: One bursts when pressure is too high; the other melts when too hot.

ch 13 slide 18

What are the two functions of a gas regulator?

Slide: Reduce tank pressure to working pressure; control O2 flow from the tank.

Simple: It lowers the pressure and lets you adjust oxygen flow.

How do single-stage and multistage regulators differ?

Slide: Most RT regulators are single-stage; multistage are less common and used for precise pressure and flow.

Simple: Single-stage is typical; multistage is for tighter control.

ch 13 slide 20

What happens inside a single-stage regulator?

Slide: Pressure is reduced in the pressure chamber so outlet pressure is 50 psi.

ch 13 slide 21

What are the three connection index safety systems?

Slide: Pin Index Safety System (PISS), American Standard Safety System (ASSS), Diameter index Safety System (DISS).

ch 13 slide 22

Which cylinder sizes use PISS and ASSS?

Slide: PISS: E tanks and smaller; ASSS: tanks larger than E.

ch 13 slide 22

What connections use DISS?

Slide: Low-pressure connections and fittings under 200 psi

ch 13 slide 22

What is the American Standard Safety System (ASSS)?

Slide: Threaded outlets of faucet-like valves on cylinders larger than E tanks.

ch 13 slide 25

What features make ASSS connections gas-specific?

Slide: Outlet diameter, threads/inch, Thread direction, internal/external threads, and regulator shape.

Simple: Each gas has a particular thread and fitting pattern to avoid mix-ups.

ch 13 slide 25

Why do facilities use bulk liquid oxygen?

Slide: Liquid oxygen stores a large volume; 1 L liquid O2 = 861 L gaseous O2

ch 13 slide 28

What conditions maintain bulk oxygen as a liquid?

Slide -118 C and 716 psi.

ch 13 slide 28

How is liquid oxygen converted to gas?

Slide: It passes through evaporator coils that warm it above its boiling point.

ch 13 slide 28

How much reserve oxygen should a facility have?

Slide: Reserve supply equal to one day of average O2 use.

cha 13 slide 29

What should facilities plan for oxygen supply failure?

Slide: Procedures and emergency protocols for response to O2 supply failure.

ch 13 slide 29

How is medical gas distributed within a facility?

Slide: Through pipes, valves, and outlets; pipes labeled at regular intervals.

ch 13 Slide 31

What pressure must the gas piping system maintain?

Slide: 50 psi throughout the entire system

ch 13 slide 31

How do primary shuttoff and zone valves differ?

Slide: Primary: where the main pipe leaves the bulk supply; zone: isolate specific areas for fire, maintenance, or construction.

ch 13 s;ode 31

How many one-way valves are on a true non-rebreather?

Slide: Three: two on the mask and one between the O2 reservoir and mask.

ch 14 slide 37

What do the two mask valves do on a true NRB?

Slide: Close on inhalation to decrease room air entrainment and open on exhalation.

Simple: They keep room air out when breathing in and out.

ch 14 slide 37

What does the reservoir valve do on a true NRB?

Slide: Opens on inhalation to breathe from reservoir; closes on exhalation to force air through mask valves.

Simple: It lets oxygen in from the bag and prevents exhaled gas from entering the bag.

ch 14 slide 37

What makes a partial non-rebreather different?

Slide: At least one mask one-way valve is removed; potentially no one-way valves remain.

Simple: A partial NRB has fewer valves than a true NRB.

ch 14 Slide 38

What valve configurations can a partial NRB have?

Slide: Examples: one valve between the bag and mask, or one mask valve plus one bag-to-mask valve.

ch 14 slide 38

What flow rate and claimed FiO2 does an OxyMask provide?

Slide: Flow rate 1-15 LPM; claims FiO2 25-90%

Why is OxyMask FiO2 variable?

Slide: It is a low-flow device with no O2 reservoir and large holes that dilute FiO2 with room air.

ch 14 Slide 42

What defines a high-flow oxygen device?

Slide: Total flow meets or exceeds the patient’s inspiratory flow rate.

ch 14 slide 44

Why can high-flow devices deliver accurate FiO2?

Slide: Correct setup prevents dilution of FiO2 with room air.

ch 14 slide 44

What are three indications for high-flow oxygen?

Slide: pts have increased inspiratory flow with need for accurate FiO2; flow-hungry patients (typically COPD); humidity via LVN.

ch 14 Slide 44

How do you titrate high-flow oxygen for oxygenation?

Slide: Adjust FiO2 per ABG or pulse ox; recalculate total flow after each change and keep it at or under 30 LPM.

ch 14 Slide 45

How do you titrate high-flow oxygen for comfort?

Slide: Increase the flowmeter to increase total flow without changing FiO2; minimum total flow: 30 LPM.

Simple: Give a flow-hungry patient more gas without raising the oxygen percentage.

ch 14 slide 45

How do air-entrainment devices increase total flow?

Slide: Venturi principle: O2 through the venturi draws room air through a port; window/restriction size affects entrainment.

What minimum total flow is needed for adult air-entrainment devices?

Slide: At least 30 LPM; use the magic box to calculate total flow.

ch 14 Slide 46

How is total flow calculated at 60% Fi02?

Slide: 60% Fi02 yields a 1:1 air-to-O2 ratio; total flow is twice the flowmeter setting

Rule of thumb: For an FiO2 of 60%, always set flowmeter at 15LPM or greater

ch 14 slide 49

What flowmeter setting is recommended at 60% FiO2?

Slide: Always set the flowmeter at 15 LPM or greater.

How do you check adequate flow when FiO2 exceeds 60%?

Slide: Increase flow until the aerosol is constant during inspiration and expiration; one setup cannot calculate total flow.

Simple: if mist disappears during inhalation, the patient needs more flow.

ch 14 slide 49

What is the function of an oxygen analyzer?

Slide: Analyzes FiO2 to determine accuracy of FiO2 delivered to the patient.

ch 14 Slide 51

How do you calibrate an oxygen analyzer?

Slide: Two-point calibration before use: room air and 100% O2.

ch 14 Slide 51

Where should the oxygen analyzer be placed?

Slide: Near the patient, with 6 inches of large-bore tubing between analyzer and patient.

ch 14 slide 51

When is a Venturi mask indicated and what is its FiO2 range?

Slide: For flow-hungry patients; FiO2 24%-50% (sometimes 55%, depending on brand).

ch 14 slide 52

What are key considerations when using a Venturi mask?

Slide: It is dry; ensure total flow meets or exceeds the patient’s inspiratory flow.

Simple: watch for dryness and make sure flow meets breathing demand.

ch 14 slide 52

What FiO2 range an an LVN deliver?

Slide: Large volume nebulizers deliver about 28-100% FiO2; they can also use room air only.

When are cool versus warm LVNs indicated?

Slide: Cool: Stridor or upper airway swelling. Warm: Copious secretions or trach tube.

ch 14 slide 54

What setup precautions are important for an LVN?

Slide: Fill with sterile water; put the drain bag at the lowest tubing point; rainout adds resistance and decreases total flow.

ch 14 slide 54

How can an LVN deliver FiO2 below its lowest setting?

Slide: Set LVN to room air at or below 30 LPM; use analyzer near patient; bleed O2 near outlet to desired FiO2.

How is total flow calculated when oxygen is bled into an LVN?

Slide: Calculate LVN setup total flow, then add the supplemental O2 flow rate.

ch 14 Slide 55

How can two LVNs be combined for FiO2 above 60%?

Slide: Wye two high-flow setups; match FiO2 and flowmeter settings; calculate one setup’s flow and double it.

What is total flow for two 70% LVNs at 12 LPM each?

Slide: One setup = 19.2 LPM; two setups = 19.2 × 2 = 38.4

What are the main components of HFNC?

Slide: Large-bore nasal prongs, heated passover humidifier, wired circuit, and air-O2 blender.

ch 14 slide 59

What FiO2 and flow can HFNC deliver?

Slide: FiO2 21-100%; flow 0-60 LPM; set FiO2 and total flow directly without the magic box.

How does hyperbaric oxygen therapy work?

Slide: Patient in an airtight chamber pressurized to greater than 1 atm, usually at 100% FiO2; greatly raises PAO2 and PaO2

ch 14 slide 61

What are HBO indications and a major risk?

Slide: Carbon monoxide poisoning, wound healing, decompression sickness; high risk of O2 toxicity.

ch 14 Slide 61

When is heliox indicated?

Slide: Partial upper airway obstruction (stridor, laryngeal mass, croup, edema) or asthma/bronchospasm.

ch 14 slide 62

Does Heliox correct the cause of obstruction?

Slide: Heliox improves gas flow but is a supportive band-aid; the actual problem must be fixed.

ch 14 slide 62

What are Heliox oxygen-flowmeter conversion factors?

Slide: 70/30 heliox: 1.6; 80/20 heliox: 1.8; actual flow exceeds indicated oxygen-meter flow

ch 14 slide 64

How do you calculate actual flow for 80/20 Heliox at 15 LPM?

Slide: 15 LPM x 1.8 = 27 LPM actual flow.

ch 14 Slide 64

What meter setting gives 16 LPM of 70/30 Heliox?

Slide: 16 LPM/1.6 = 10 LPM on an O2-calibrated flowmeter.

ch 14 slide 64

What is inhaled nitric oxide (iNO)?

Slide: A selective pulmonary vasodilator that reduces pulmonary vascular resistance without changing systemic resistance.

ch 14 slide 65

Which vessels are dilated by inhaled nitric oxide?

Slide: Only the vasculature of ventilated alveoli.

ch 14 slide 65