Oxygen Administration Decision Making

These questions are important:

Complaint/injuries

Mental/status

Oxygen saturation

Level of distress

Physical signs

94% Oxygen Saturation (Adequate amount of Oxygen)

If they are below in the low 90s a nasal canula is appropriate.

This is particularly important with high priority patients.

Skin signs show that they are in need of oxygens (pale, cool, and clammy)

Respiratory Distress vs Respiratory Failure

Ventilate or put on oxygen

Not all the oxygen that we breathe reaches the lungs.

Respiratory arrest: that state where the patient is not breathing.

Agonal breathing: DYING BREATHS. Are not really considered to be proper breaths.

Definition of agonal breathing: pattern of breathing characterized by labored, gasping breaths that occur because of insufficient oxygen.

Respiratory Distress Respiratory Failure

Characterized by difficulty breathing, shortness of breath, or a rapid breathing. Severe condition where the respiratory system fails to adequately exchange oxygen and carbon dioxide in the blood.

A condition in which a person experiences difficulty in breathing or an increased effort to breathe. It is often a sign of an underlying respiratory problem and requires immediate medical attention. Can follow respiratory distress and causes more severe difficulties with gas exchange.

Key differences. While respiratory distress refers to the presence of breathing difficulties, respiratory failure occurs when the respiratory system fails to provide adequate oxygenation to the body or remove carbon dioxide effectively. In other words, respiratory failure is a more severe form of respiratory distress. There are two main types:

Acute respiratory failure:

Characterized by a sudden and severe inability to breathe properly,

Chronic respiratory:

Characterized by the failure develops gradually over time.

Causes:

Lung diseases (asthma)

Chronic pulmonary disease (COPD)

Pneumonia

Acute respiratory distress syndrome (ARDS)

Heart failure

Severe allergic reactions

Pulmonary embolism

Certain infections. Causes:

Chronic obstructive pulmonary disease (COPD)

Pneumonia

Asthma

Pulmonary embolism

Respiratory muscle weakness

Drug overdoses

Severe trauma

Neuromuscular disorder.

Symptoms:

Rapid/shallow breathing

Shortness of breath

Wheezing

Chest tightness

Increase heart rate

Severe cases

Cyanotic Symptoms:

Shortness of breath

Rapid breathing

Wheezing

Cyanosis (bluish discoloration of the skin)

Confusion

Extreme fatigue

Respiratory failure occurs when the respiratory system is unable to adequately oxygenate the blood or remove carbon dioxide from the body. There are two main types of respiratory failure: hypoxemic respiratory failure and hypercapnic respiratory failure.

Hypoxemic respiratory failure (Type 1):

Characterized by low levels of oxygen in the blood.

This can occur due to various reasons such as pneumonia, acute respiratory distress syndrome (ARDS), pulmonary embolism, or any condition that impairs the exchange of oxygen and carbon dioxide in the lungs. In hypoxemic respiratory failure, the oxygen levels in the arterial blood are below normal, usually less than 60 mmHg.

Hypercapnic respiratory failure (Type 2)

is characterized by high levels of carbon dioxide in the blood. This type of respiratory failure typically occurs due to a decrease in the ability to remove carbon dioxide from the body. It is commonly seen in conditions such as chronic obstructive pulmonary disease (COPD), asthma exacerbation, or severe pneumonia. In hypercapnic respiratory failure, the carbon dioxide levels in the arterial blood are above normal, usually greater than 45 mmHg.

Mental Status

Hypoxia = shock

Anxious/ restless = can be leading symptoms to mental status.

The brain is not able to function without oxygen.

A patient that has normal mental status is most likely not in respiratory distress.

Skin color, temperature and condition

Pale: blood is getting shunted away from the surface where it is not needed.

Blood going to important organs where it is needed.

Low blood sugar patients: present with pale and cool skin. Body is releasing epinephrine. Causes the body to go into flight or fight.

Pulse Pressure

Systolic and diastolic pressure.

Blood pressure readings are composed of two numbers, the systolic and the diastolic pressure. The systolic pressure measures the pressure in your arteries when the heart beats, and the diastolic pressure measures the pressure in your arteries between each heartbeat.

(Systolic (top number))⁄(Diastolic (bottom number))

Respiration vs Ventilation

Respirations: the exchange of gases

Ventilation: is about the movement of air in and out of the chest.

Tidal Volume: Amount of air measured in milliliters that moves in or out of the lungs every respiratory cycle.

Measured in mls 6-8 mls/kg IBW.

Minute Volume refers to the volume of air that is moved in and out of the lungs in one minute. Respiratory Rate x the Tidal Volume = volume the pt is taking every minute.

Respiratory Rate: Breaths taken in 1 minute.

Types of breathes

Minatory:

Assisted/supported.

Spontaneous

Dead air space: Unventilated air space. Volume of air that is inhaled but does not take part in the gas exchange. It is trapped in space/placed that does not participate in the exchange of gases.

Supraglottic: upper part of the larynx

Shock:

Is a progressive state of cellular hypoperfusion. It occurs when the circulatory system doesn’t have enough pressure to allow oxygen to each all the organs. There are four major categories of shock.

Cardiogenic shock: problems associated with the heart’s function.

Hypovolemic shock: total volume of blood available to circulate is low.

Septic shock: caused by overwhelming infection, usually bacteria.

Anaphylactic shock; severe allergic reaction.