emergency medicine

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emergency medicine
2014-02-19 19:25:13

notes on chapter 7
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  1. what are the equipments available for oxygen therapy and mechanical ventilation
    • 50psi regulator with flow gauge
    • pressure compensated flowmeter(hangs on wall)
    • oral suction
    • e-size oxygen cylinder
    • oxygen connecting tubing (1/4 inch)
    • suction catheter
    • nasal catheters (varying size)
    • e-collar
    • endotracheal tube
  2. ways to determining the need for o2
    • observe the respiratory patterns and effort
    • chest wall auscultation
    • chest wall palpation
    • oral exam
  3. "At the _____ sign of _____, administer O2
    • first
    • hypoxia
  4. observation-signs indicating some degree of hypoxia
    • nasal flaring
    • irregular chest wall movement
    • "panting"
    • cyanosis
  5. auscultation- what are you listening for?
    • bubbling
    • gurgling
    • wheezing
    • unusual sounds
    • lack of sound
  6. harsh sounds means
    increased sound on expiration (usually quiet when exhaling)
  7. crackle sounds mean
    fluids in the airways like blood or pus
  8. wheezing sounds mean
    airway obstruction
  9. decrease sounds mean
    fluids or air in the pleural space or air in tissues
  10. chest wall palpation-what are you feeling for?
    • swelling
    • contusions
    • punctures
    • any distortion
  11. monitoring devices-pulse oximetry
    • commonly used
    • will determine how well the hemoglobin is saturated by a precentage
    • does not determine how well the animal is ventilating
  12. monitoring devices-fractional inspired O2 (FiO2)
    • amount of O2 in enviroment/system
    • evalutes whether the animal is able to oxygenate normally
  13. monitoring devices-arterial blood gas
    • PaCO2-indicates ventilation
    • PaO2-indicates ventilation/perfusion
  14. 5x FiO2 Rule
    • estimates where PaO2 should be if heathy
    • room air=100% PaO2
  15. PaO2 : FiO2 ratio (%/% as decimal)
    • mild disease=300-500
    • moderate disease=200-300
    • severe disease= less than 200
  16. oxygen
    • can have a drying effect on MM
    • generally has a calming effect
    • high doses can cause euphoria
  17. sedation
    • used when stressed by O2 supplementation
    • any type can compound resporatory distress
    • monitor closely for apnea (resp drive to stop)
  18. what are some things used to deliver oxygen?
    • blow by/flow by
    • bag
    • nasal catheter
    • nasal prongs
    • nasal tracheal catheters
    • transtracheal oxygen
    • oxygen mask
    • oxygen collar
  19. blow by or flow by
    • hold end of O2 line 6 inches from the nares/mouth- do not aim directly at the nose
    • 6 L/min flow rate- FiO2 less then 35% due to mixing
    • easy first type of support
  20. bag method
    • used for small to medium animals in carrier
    •     enclose the carrier in a clear plastic bag and the O2 line administers high flow of O2
    • temporary support until others started
    •     initial stress free suppot, allows setup for other types of support or sedation, use 30 min or less because it lacks ventilation
  21. nasal O2 catheters
    • red rubber feeding tube (RRFT) approriate-silicone best because less irritating to nasal mucosa to which dried mucus does not adhere
    • 3-8 french catheter (fr)
    • topical anesthetic-crunch nose up, ventromedial angle
    • super glue or sutures
    • humidification
    • FiO2 about 40-50%
  22. nasal prongs
    • depends on space between the nostils
    • flow rate of 3-6 L/min- FiO2 40-50%
    • still can cause irritation so best to use topical anesthetic
    • humidification
    • check frequently because slips out easily
    • suture or staple in place
  23. nasal tracheal catheters
    • placed like nasal catheters- extend to epiglottis and into trachea
    • used in larygeal disease or collapse trachea (CT)
    • can supply more then 50% FiO2
    • not tolerated well and higher complications -coughing due to contact with epiglottis, topical anesthesia of area, mild sedation often needed, inceased risk of aspiration
  24. transtracheal oxygen
    • surgically placed catheter- same as nasal or tracheal silicone best
    • prep and local block at 4th-5th ring
    • puncture to facilitate catheter intoduction
    • tip of catheter to the carina
    • approximate flow rate of 3 L/min- based on ventilation, PaO2-deep and rapid +/- increase rate
  25. oxygen collar
    • less restrictive and irritating than others
    • low flow rate?yes
    • homemade with e-collar and saran wrap
    • O2 heavier than air-lower 2/3 O2 rich
    • humidity and heat-keep eyes moist, watch for xs humidity and heat
  26. oxygen cage and incubators
    • not the best for critical control
    • flow rate 15 L/min might give FiO2 40%-leaks significant, dead space
    • open freguently so long "recharge" period
    • bacterial growth in humidifiers-pseudomonus
  27. hyperbaric oxygen
    • 100% oxygen at more than normal pressure
    • O2 in blood and tissue up to 20x normal
    • treatment for- carbon monoxide, nonhealing wounds, bone/joint infections from septicema, crush injury
    • few exist in vet machine