Professional Documents
Culture Documents
ABC
Air goes in and out, blood goes round and round. Any variation on this is a bad thing. Airway obstruction needs to be addressed immediately
Respiratory failure
Type 1 (hypoxemic) Saturation < 90%. PaO2 <60 mm Hg
Type 2 (hypercapnic) PCO2>50 mmHg, pH<7.35
Definitions
Hypoxemia
Hypoxia
Hypoxemia
Low alveolar oxygen tension (ambient, hypoventilation) Ventilation-perfusion mismatch Right to left shunt (venous admixture) intracardiac extracardiac Impaired oxygen diffusion (uncommon)
Alveolar gases
V/Q mismatch
Ventilated but not perfused: increased dead space ventilation, VT=VD+VA VD= VD equipment + VD anatomic + VD physiologic Perfused but not ventilated: shunt >20% Shunt fraction, minimal improvement with increased FiO2
Hypoxia
Hypoxemic Hypoxia Anaemic Hypoxia Stagnant Hypoxia ( distributive or low CO) Histotoxic Hypoxia VDO2= CO x Hb x SAT/100 x 1.34ml/gHb+ (PaO2 x 0.003mlO2/100ml/mmHg)
Treatment I
Empiric oxygen treatment Cardiac/ respiratory arrest Hypotension Respiratory Distress Trauma GCS decrease from any cause Postoperative
Treatment II
Verify hypoxemia Pulse oximetry ABGs Start Oxygen treatment. Treatment goal ( sat level) Administration mode, flow, when to stop
The oxyhaemoglobin dissociation curve showing the relation between partial pressure of oxygen and haemoglobin saturation
Bad medicine
To withhold Oxygen out of fear of hypercarbic ventilatory failure is poor practice Identify patients at risk (COPD) Use Venturi masks 0.24 -0.28 ---- FiO2. ABGs/ O2-sat to direct therapy Support ventilation (BiPAP, intubation)
Oxygen Hazards
Fire ( airway fires) Tissue toxicity, pulmonary and retina Decreased hypoxemic drive and increased VD in COPD. Seizures (hyperbaric) Mucosal damage due to lack of humidity
Oxygen administration
Low flow systems
High Flow systems (HFOE)
Nasal Prongs
Non-rebreather
Venturi Mask
Venturi valve
Long term oxygen therapy prolongs survival in hypoxaemic patients with COPD when used for ≥15 hours/day. (Results from the nocturnal oxygen therapy trial (NOTT) and the MRC trial)