Medical Gas Therapy

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Author:
Anonymous
ID:
199511
Filename:
Medical Gas Therapy
Updated:
2013-02-10 19:14:59
Tags:
Respiratory Therapy
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Description:
Respiratory Therapy
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  1. Goals of O2 therapy 
    • Relieve hypoxemia - PNA,V/Q mismatch
    • Decrease WOB - asthma,COPD
    • Decrease work of heart -MI,pul edema
  2. O2 induced hypoventilation 
    Complication O2 therapy in patient who breaths on hypoxic drive (COPD)
  3. Signs of O2 induced hypoventilation
    • Decreased RR & Vt
    • Increase PaO2 & PaCO2, Decrease pH
    • Pt sensorium-lethargic, sleepy confused
  4. Treatment of O2 induced hypoventilation
    Decease level inspired oxygen
  5. Difference between high flow and low flow
    • High flow supply patients entire inspired vol.
    • Low flow systems part patients inspired vol.
  6. Qualifications low flow
    • Vt: 300-700ml
    • RR:<25pbm
    • Regular vent pattern 
  7. What is needed when charting medical gas
    • Percent or flow of oxygen
    • Type device utilized
    • Duration oxygen use
    • Doctors signature 
  8. Low Flow devices
    • Nasal Cannula
    • Simple Mask 
    • partial Rebreather mask
  9. Nasal Cannula
    • FiO2: 0.24-0.45
    • Flow: 1-6 l/min
    • Initial O2 device COPD, patients with stable RR and Vt
  10. Simple Mask 
    • FiO2: 0.40-0.55
    • Flow: 6-10 l/min
    • Set @ least 6 l/min to flush out exhaled CO2
  11. Partial Rebreather Mask 
    • FiO2: 0.60-0.65
    • Flow: 6-10 l/min
    • Has no one way flap valves
  12. Non-rebreather mask
    • FiO2: 0.21-1.0
    • has 3 one way valves
  13. Troubleshooting Non-rebreather mask
    • If bag collapses increase flow
    • If patient inhales & bag doesn't contract slightly
    • mask not tight, seal mask
    • Nonrebreathing valve stuck, replace mask
  14. Air entrainment mask/venturi mask 
    • Delivers precise FiO2 (ideal COPD)
    • FiO2 will increases 
    • internal diameter of gas injector, increases
    • increased resistance or obstruction downstream
    • FiO2 deceased size of air entrainment ports increased
    • Total flow increases as size of air entrainment port increases 
  15. Briggs Adapter (T-piece)
    • FiO2: 0.21-1.0
    • See aerosol reservoir tubing during inspiration
    • If aerosol disappears: increases flow, add more reservoir tubing, set up device provide more flow
  16. Aerosol masks, trach collars (mask) and face tents 
    • FiO2: 0.21-1.0
    • RA wont enter as long as device flow exceeds inspiratory flow. 
  17. Oxygen Hood
    • Flow range 7-14 L/min
    • Monitor Temp 
    • Overheating cause dehydration & apnea
    • Underheating increase O2 consumption
    • Amplifies surrounding noise level-use humidifier instead of nebulizer 
  18. Mist tent, oxygen ten, croupette 
    • Peds
    • Flow 0.40-0.50
    • Monitor O2 near infants face 
    • O2 may layer w/higher FiO2 in lower layers 
    • Monitor infants fluid overload-weight gain. 
  19. Incubator (isolette)
    • Administer O2 to neonate by cannula, oxyhood,CPAP
    • Provides humidity
    • Ideal stable newborns
  20. Helium/Oxygen Therapy (He/O2)
    • Pts increased airway resistance edema foreign body obstruction, partial vocal cord paralysis
    • Decrease WOB delivers low density gas that can maneuver around obstructions.  
  21. Calculate actual flow delievered
    • 1.8=80/20 mix
    • 1.6=70/30 mix

    80/20 He/O2, flow 10 l/min actual flow 18 l/min 10X1.8=18 L/Min

    Administerd nonrebreathing mask 
  22. Nitric Oxide (NO) Thearpy
    • Relax smooth muscle, improves blood flow to alveoli 
    • Improves V/Q mismatch
    • Decrease PVR & pulmonary pressures 
    • Improves oxygenation 
    • Results selective pulmonary vasodialtion 
  23. Indications Nitric Oxide (NO) therpy
    • Persistant pulmonary hypertension of Newborn
    • Pulmonary Fibrosis
    • Pulmonary Embolism
    • Congenital Heart defects
    • Chronic lung disease
    • Heart & lung transplant 
  24. What dose do you start nitric oxide?
    Start does 20 ppm. Up to 80 ppm given w/out major side effects 
  25. Cylinder equation
    •    (PSI) X tank Factor
    •          Liter Flow

    • E cylinder: 0.28
    • H cylinder: 3.14
    • 2200 psi 
  26. Massive leak occurs after removing flowmeter
    • Try reinserting into wall
    • Contact personal & supply O2 to patient
    • Turn off zone valve 
  27. Air Oxygen proportioners (blenders) 
    • Control mixing air & O2 to get specific FiO2
    • Used w/non-rebreather mask to acheive precise FiO2
  28. Calculate Total Flow 
    Flowmeter setting X Factor or FiO2 X factor
  29. Air Oxygen Entrainment Ratios
    28
    36
    40
    60
    • 28      10:1
    • 36      4:1
    • 40      3:1
    • 60      1:1

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