Therapeutic Gas Administration

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2. Oxygen Therapy. Gas treatment is most normal methodology of RCRC rose from the introduction of O2 as a restorative TXMedical gasses are drugsRT\'s survey requirement for treatment, suggest

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Therapeutic Gas Administration

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Oxygen Therapy Gas treatment is most regular methodology of RC ascended from the introduction of O2 as a restorative TX Medical gasses are medications RT's survey requirement for treatment, suggest & direct dose, , decide objectives of treatment, screen reaction, adjust treatment likewise, & record their information in the pt record (graph)

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Oxygen Therapy General Goals/targets Correcting Hypoxemia By raising Alveolar & Blood levels of Oxygen Easiest goal to achieve & measure Decreasing side effects of Hypoxemia Supplemental O2 can help mitigate manifestations of hypoxia Less dyspnea/WOB Improve mental funx

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Oxygen Therapy Goals/destinations - cont'd Minimizing CP workload CP framework will make up for Hypoxemia by: Increasing ventilation to get more O2 in the lungs & to the Blood Increased WOB Increasing Cardiac Output to get more oxygenated blood to tissues Hard on the heart, particularly if infected Hypoxia causes Pulmonary vasoconstrix & Pulmonary HyperTxn These cause an expanded workload on the correct side of heart Over time the correct heart will turn out to be more strong & then in the long run fall flat ( Cor Pulmonale ) Supplemental o2 can ease hypoxemia & calm aspiratory vasoconstrix & HyperTxn , lessening right ventricular workload

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Oxygen Therapy AARC CPG p869 O2 % conveyed FiO2

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Oxygen Therapy Assessing the requirement for oxygen treatment 3 fundamental ways Laboratory measures – obtrusive or noninvasive Clinical Problem or condition Symptoms of hypoxemia

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Oxygen Therapy Assessing the requirement for oxygen treatment Laboratory measures – intrusive or noninvasive PO2 – incomplete weight of oxygen P An O2 – Partial Pressure of Oxygen in Alveoli PaO2 – Partial weight of Oxygen in blood vessel blood Hgb Saturation SaO2 - Arterial Saturax of Oxyhemaglobin SpO2 – Pulse Oximetry of Oxyhemaglobin Saturax

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Oxygen Therapy Assessing the requirement for oxygen treatment Clinical Problem or condition Specific clinical issues or conditions that where hypoxemia is basic Post operation COPD PE Etc.

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Oxygen Therapy Assessing the requirement for oxygen treatment Symptoms of hypoxemia T38-1 Respiratory, Cardiovascular, & Neurological Tachycardia, Tachypnea , hypertxn , cyanosis, dyspnea , disorientax , clubbing, and so forth

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Oxygen Therapy Asessing the requirement for RT will consolidate objective & subjective measures to affirm deficient oxygenax Often suggest administrax construct exclusively in light of subjective measures

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Oxygen Therapy Design & Performance T38-3 Requires master inside and out information RT v. RN What is the FiO2 territory? Low = <35% Mod = 35-60% High = >60% Does the FiO2 stay settled or variable when pt request changes Fixed FiO2 does not differ Variable FiO2 fluctuates when pt changes Dependant on gave stream & Pt demand

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Oxygen Therapy Design & Performance T38-3 Low stream Flow does not take care of inspiratory demand O2 is weakened with air on motivation Nasal Cannula Nasal Catheter Xtracheal Catheter Resevoir Cannulas Mustache Pendant

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Nasal Cannula

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Oxygen Therapy Low Flow Devices Nasal Cannula Adult 0-6 l/m >4L requires Humidity Can bring about irritax , dryness, dying, and so on. General guideline Nasal With ordinary rate/profundity [4 X (L/M)] + 20 = ~ FiO2 24-44% Neo 0-2 l/m

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Oxygen Therapy Low Flow Devices Nasal Catheter Adult Visualize position or oblivious to profundity = to length of nose to tragus Replace Q8hrs Affects discharge, irritax , and so on. Useful for short methods bronchoscopy

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Oxygen Therapy Low Flow Devices Xtracheal catheter Surgically embedded in trachea Uses trachea/upper aviation route as repository Requires low streams to address issues

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Oxygen Therapy Low Flow Devices Performance Characteristics of Low Flow FiO2 shifts with measure of air weakening, pt dependant Must evaluate reaction to treatment Rule of thumb Nasal Cannula With typical rate/profundity [4 X (L/M)] + 20 = ~FiO2

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Oxygen Therapy Low Flow Devices Troubleshooting Low Flow Obstrux Displacement Irritax Reservoir Systems Builds O2 supply in supply b/w breaths Reduces air dilux Reduces O2 utilize, expanded utilizax Provides higher FiO2 @ bring down streams

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Oxygen Therapy Low Flow Devices Reservoir Cannula Frequent substitution No humidificax Requires nasal exhalax Nasal Stores ~20ml Esthetically disappointing Pendant Better tastefully Extra weight can disturb ears/confront

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Oxygen Therapy Low Flow Devices Resevoir veils Simple Mask Non-Rebreather Partial Non-Rebreather Non-rebreathing resevoir circuit

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Low Flow Devices Reservoir Masks Simple Mask Gas accumulates in cover Exhalax ports Air entrained through ports & around cover 5-10 L/M <5 = CO2 rebreathing >10 = utilize more obtrusive veil

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Partial rebreather Non-rebreather

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Low Flow Devices Reservoir Masks Partial rebreather Utilizes 1L store sack & cover No valves 1 st third (dead space) is inhaled into supply pack & rebreathed Air entrainment from ports & around cover Adequate stream the length of store pack does not crumple on inspirax

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Low Flow Devices Reservoir Masks Non-rebreather Utilizes one way valves b/w supply & veil on one exhalax port release unrestrained choice give 100% >~70% FiO2 is uncommon Hard to give release free framework

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Low Flow Devices Reservoir Masks Non-rebreathing store circuit Principal Same as veil framework Resevoir Can be bit of blue tubing or res sack Can be utilized with Tpiece on Trach/ETT Utilizes safeguard delta valve

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Low Flow Devices Reservoir Masks Troubleshooting store frameworks Irritax Obstrux dislodgement

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Low v. High Flow v. Resevoir

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Oxygen Therapy High Flow Devices High Flow Supplies given FiO2 @ streams higher than inspiratory request Peak I Flow = 3 X Minute Ventilax Minute Vent = f x Vt 20L/m is upper end of typical Minute Ventilax (60L/M) Uses Entrainment or Blenders

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Oxygen Therapy High Flow Devices Principles of Gas Mixing- E38-1 Find FiO2 When you know air & O2 streams E38-2 When given a FiO2, discover air:O2 proportion & add up to Flow Magic Box E38-3 O2 & wind current required for a given FiO2 & add up to stream -

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E38-1 Find O2 %, Air & O2 stream given What is the O2 % when blending 6L of O2 & 6L of Air? O2% = (Air stream x 20) + (O2 stream x 100) Total Flow = (6 x 20) + (6 x 100) 12 = (120) + (600) 12 =60%

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E38-2 given FiO2, discover proportion & add up to stream Order to convey 40% O2 Air = 100-FiO2 O2 FiO2 – 20 = 100 40-20 = 60 = 3 = 3 sections air 20 1 section O2 If O2 flowmeter is set at 5L/m, you are entraining 15L/m Air. Add up to stream = 20L/m

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Air 100 – Fio2 = 30 = 3 = 0.6 sections air to 1 section O2 20 - Fio2 50 5 1 If O2 flowmeter is set at 6L/m air entrained = 3.6L/m, O2 stream = 6L/m total stream = 9.6 L/m

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E38-3 Given FiO2 & Total stream, discover stream to set your O2 flowmeter to FiO2 requested = .35 Total stream = 60L/m O2 Flow = ( add up to stream) (FiO2-20) 79 = (60 l/m) (35 – 20) 79 set O2 flowmeter = 11.4 l/m

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Oxygen Therapy High Flow Devices Air Entrainment framework Amount of air entrained fluctuates specifically with port size & speed The more air entrained Higher stream Lower FiO2

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Oxygen Therapy High Flow Devices - Entrainment FiO2 relies on upon Air to O2 proportion (measure of air entrained) Downstream resistance (backpressure) Increased resistance Decreases entrainment Decreases add up to stream Increased FiO2 %O2 conveyed may increment however FiO2 may diminish do to inadequate stream for Insp request

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Oxygen Therapy High Flow Devices - Entrainment Input stream changes ostensible impact on FiO2 changes add up to stream Magic Box Only for estimax For exactness utilize E38-2

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Oxygen Therapy High Flow Devices - Entrainment AE Devices AEM (Venti-Mask) AE Nebulizer (Large Volume Nebulizer) cool/warmed Aerosol

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Oxygen Therapy High Flow Devices - Entrainment Air entrainment mask Adjustable air entrainment ports & planes to accurately control FiO2 & stream Higher the stream, bring down the FiO2 (converse relaxship) the other way around For exact FiO2's aggregate stream must be >Insp Demand (top Insp stream) (3 X min vent) Aerosol neckline Allows association of a humidified gas to the entrainment port

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AEM

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Oxygen Therapy High Flow Devices - Entrainment Air Entrainment Nebulizer (cool/warmed vaporized veil) Same as cover aside from Additional Temp & Humidity control Allows for administrax of particulate water (sterile) to aviation route Great for trach's (warmed) Airway edema (cool) Have settled planes, port is just factor Limits O2 stream to 12-15 l/m Provide settled FiO2 just when aggregate stream surpasses Insp Demand Face tents give less steady FiO2

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Oxygen Therapy High Flow Devices – Entrainment LVN cont'd Determining if add up to stream is adequate Visual inspex Aerosol Mist is seen leaving tubing on Insp & stream is consistent Pt Vt contrasted with neb flow

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Oxygen Therapy High Flow Devices – Entrainment Troubleshooting air entrainment frameworks Affected by downstream resistance Water in tubing Obstrux

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Oxygen Therapy High Flow Devices – Entrainment Providing moderate to high Fi02 @ high stream @100% a LVN can just give 12-15L/M To be a genuine High Flow gadget it must guarantee consistent FiO2 by giving full insp request

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Oxygen Therapy High Flow Devices – Entrainment Providing moderate to high Fi02 @ high stream Methods Add supply tubing if intubated or trached Closed repository 3-5

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