Administration of Oxygen

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Administration of Oxygen

• Need for Oxygen
• Hazards
• Delivery Devices
• Hyperbaric Oxygen
• Other Medical Gases

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5 Indications for Oxygen Therapy

• Suspected or Documented hypoxia
• Severe trauma
• MI
• Post op

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Hazards of Oxygen Therapy

• Ventilatory depression
• Absorption atelectasis
• ROP
• Oxygen toxicity
• Fire hazard
• Contamination

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Delivery DevicesLow and High Flow

• Getting the gas to the patient

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Low Flow Device Definition

• FiO2 can vary with
• Patients respiratory rate and pattern
• Flow of gas from the equipment
• Equipment reservoir
• Does NOT fully meet patients inspiratory demand
• Needs additional mixing with room air

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Low Flow Oxygen

• Low Flow
• Nasal cannula
• Simple oxygen mask
• Non-rebreathe mask
• Face tent

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Nasal Cannula
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Nasal Cannula

• Delivers about 24 to 44 FiO2
• Flow is set at 1 to 6 liters for adults
• 0.1 to 0.9 with newborns (special flowmeter)
• FiO2 varies with patient respiratory rate and
  volumes
• Add moisture over 4 L/min or with pt comfort

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Simple Mask
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Simple Mask

• Delivers 40 to 50 oxygen
• Need at least 5 L/min to flush out CO2

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Non RebreatheMask
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A reservoir system

• Delivers better oxygenation then simple mask.
• The most oxygen without intubation
• 50 to 70 oxygen (some say 80-90-100)

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Something New (VIASYS)
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The Hi-Ox 80
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Helps patients more ways than one

• Provides an FiO2 of gt80 at a flow of 8 L/min
• Studies show that high FiO2
• Reduces nausea post operatively
• Reduces s/p infections by 50

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Trach Mask
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Trached?

• Usually blue tubing connected to heated aerosol.
• Can use transport tee

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T-piece
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Tee Piece

• Must be intubated
• With aerosol mist setup or transport tee

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Face Tent
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Face Tent

• Ideal for post anesthesia
• Not enclosed and claustrophobic
• Only for low oxygen concentrations

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Delivery DevicesHigh Flow

• Venturi (Entrainment) Mask
• Aerosol mist setup

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Definition of High Flow

• Meets or exceeds patient inspiratory demand
  (usually textbook of 30 LPM)
• Provides precise concentrations despite patients
  breathing pattern

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Why 30 Liters per minute?

• Based on minute volume
• Respiratory rate times tidal volume
• The number of breaths multiplied by the size of
  the breaths
• People inspire one-third of the time.

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Air Entrainment Mask
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Venturi Masks
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Entrainment Ratios
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Venturi High flow device

• Ideal for use with CO2 retainers
• Matches patient demand
• Usually 24 to 50 (some have up to 100 running
  at flush)

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Aerosols and Nebulizers

• Jet nebulizers
• Small volume nebs
• Aerosol setups
• Aerosol output calculations
• Aerosol density calculations

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Keep the flow up!
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Monitoring Oxygen Therapy

• Pulse Oximetry
• Arterial Blood gases
• Work of Breathing
• Tidal Volume and Respiratory Rate
• Pulse and Blood Pressure

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Less common used O2 delivery

• Head hoods
• Pendant or reservoir nasal cannula
• Bi-flow
• Tracheal catheters
• Croup tents
• Incubators
• Hyperbaric chamber

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Head Hood
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Head Hood

• Newborns only
• Watch for cooling

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Pendant Reservoir
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Reservoir Cannula
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(No Transcript)
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Nasal Biflow
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Tracheal Catheter
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Nasal Catheter
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Oxygen (Croup) Tent
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Croup Tent

• Can supply 30 to 50 oxygen

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Incubator
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Oxygen Blender
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Functional Diagram of Blender
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Blenders

• Found on all ventilators
• Easiest and most accurate way to deliver oxygen
  at precise percentages

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Even Less Commonly Used
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Hyperbaric Oxygen (High Pressure Oxygen)

• Monoplace Chamber
• Multiplace Chamber

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Hyperbaric Oxygen

• Used to increase the amount of oxygen carried in
  the blood.
• HENRYS LAW the amount of gas dissolved in a
  liquid is directly related to the partial
  pressure of the gas(es) above the liquid.

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Hyperbaric Oxygen

• Reduce the size of the air bubbles in the body
• Air Embolism
• Decompression sickness
• Boyles Law Pressure and Volume are inversely
  related.

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Indications for HBO

• Decompression sickness
• Diver with the bends
• Gas Embolism
• Reduces the size of the bubbles
• Carbon monoxide and Cyanide poisoning
• Decreases half life of CO bond
• Severe anemia (blood loss)
• Wound healing
• Ischemic skin grafts, flaps, burns

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Monoplace HBO Chamber
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Hyperbaric Chambers
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Other Gases

• Carbogen
• Heliox
• Nitric Oxide

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Carbogen

• Usually 95 oxygen and 5 carbon dioxide
• Treats singulitus (hiccups)
• Provides a challenge to stimulate breathing in
  some patients

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Heliox

• Useful with ventilators and in ER
• Upper airway narrowing
• Croup
• Asthma
• Stridor
• Tracheal tumors
• The less dense gas is ideal for the tight passage
  through a narrow passage

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Nitric Oxide

• Treatment of neonates with hypoxic respiratory
  failure associated with pulmonary hypertension
• A significant improvement has been noted with
  premature infants

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Nitrous Oxide

• Used with anesthesia
• Dont get confused between NO and N2O

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Thats all folks