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Oxygen delivery devices

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This is a PowerPoint presentation about oxygen delivery device, their advantages, disadvantage, and limitation.

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Oxygen delivery devices

  1. 1. Essentials course in EMEssentials course in EM hospital-based  Emergency care: 1. Pre-hospital EMS 2. Hospital-based. 3. Disaster management To Oxyen DevicesTo Oxyen Devices By Dr. Fekri Eltahir Abdalla
  2. 2. Oxygen Delivery Devices By Dr. Fekri Eltahir Abdalla
  3. 3. Oxygen Delivery Systems By Dr. Fekri Eltahir Abdalla
  4. 4. Types of hypoxia Types Definintion Typical cases Hypoxic oxygen tension High altitude – hypoventilation – V/Q mismatch. Anemic carrying capacity Anemia – blood loss – CO poisoning Stagnant perfusion Heart failure – Shock – ischemia Histotoxic Cellular hypoxia Cyanide – other metabolic poisons – shifting of O2-HB curve. By Dr. Fekri Eltahir Abdalla
  5. 5. Oxygen dissociation curveOxygen dissociation curve By Dr. Fekri Eltahir Abdalla Decreased Temp. Decreased 2,3 DPG Decreased {H+} Increased Temp. Increased 2,3 DPG Increased {H+}
  6. 6. Grading of hypoxia By Dr. Fekri Eltahir Abdalla Respiratory failure
  7. 7. How to manage Hypoxia By Dr. Fekri Eltahir Abdalla LOC Resp. effort Chest exam
  8. 8. Oxygen dose By Dr. Fekri Eltahir Abdalla
  9. 9. Oxygen dose By Dr. Fekri Eltahir Abdalla
  10. 10. Device characteristics Device Mask Reservoir Total storage Nasal prongs No 50 ml (DS) 50 ml Simple mask 100 – 200 ml 50 ml (DS) 150 – 250 ml Mask reservoir 100 – 200 ml 650 – 1050 ml 750 – 1250 ml Venturi mask 100 – 200 ml 50 ml (DS) 150 – 250 ml DS = dead space = air in the hypopharynx. Mask reservoir = partial rebreathing & non-rebreathing masks. By Dr. Fekri Eltahir Abdalla
  11. 11. Patient demand By Dr. Fekri Eltahir Abdalla Hypoxia
  12. 12. Respiratory Failure By Dr. Fekri Eltahir Abdalla Type 2 (Hypercapnic RF)Type 1 (Hypoxemic RF) PaO2 < 60 mmHg PaCO2 ( low or normal) PaO2 < 60 mmHg PaCO2 > 45 mmHg COPD patient with PaCO2 of 60 mmHg, PaO2 of 61 mmHg and pH 7.37. Is there any RF? Which type? ABG Not Oximeter
  13. 13. PaO2-FiO2 ratio  Normal PaO2/FiO2 is 300-500  <200 indicates a clinically significant gas exchange derangement  Ratio often used clinically in ICU setting By Dr. Fekri Eltahir Abdalla
  14. 14. Oxygen Devices ClassificationOxygen Devices Classification By Dr. Fekri Eltahir Abdalla
  15. 15. Oxygen Devices ClassificationOxygen Devices Classification By Dr. Fekri Eltahir Abdalla
  16. 16. By Dr. Fekri Eltahir Abdalla Oxygen Devices ClassificationOxygen Devices Classification
  17. 17. Nasal Prongs By Dr. Fekri Eltahir Abdalla
  18. 18. Nasal Prongs Advantages Disadvantages Tolerable (satisfaction + compliance) Flow limitation.? Can use the mouth (eat, speak, treat) FiO2 limitation.? Avoid high FiO2 in COPD. Nasal drying and irritation with high flow rate? By Dr. Fekri Eltahir Abdalla
  19. 19. Case 1:  A young female presented with dry cough, fever and SOB. She was found hypoxic at the triage (Sat 87%). The nurse put her in oxygen using nasal prong at flow of 4 L/min. She improve a little pit to 91% saturation. What your next best action to improve her oxygenation? A. Shift her to simple mask at 5 L/min. B. Shift her to non-rebreathing mask at 5 L/min C. Increase the nasal prong flow to 5 L/min D. No need to make any change. By Dr. Fekri Eltahir Abdalla
  20. 20. Simple mask Characteristics Advantages Disadvantages Flow not < 5 L/ min CO2 retention Higher FiO2 compared to nasal prong Loose = air leak, mixed room air (lower FiO2) Loosely fitted to the face Air leak – mixed room air Can use nebulizer. Can not use the mouth to eat, drink, speak Max flow rate = 10 L/ min FiO2 = 40 – 60 % Approx = 4%/L/min Can use venture. Limited FiO2 (Max 60%) Pt demand not met in some cases. No reservoir bag Storage ? By Dr. Fekri Eltahir Abdalla
  21. 21. Case 1 continued  As the patient had oxygen flow rate of 5 L/ min, her saturation reached 93% for 15 min then she dropped again to 89%. The nurse increased the flow to 6 L/min using nasal prong but the saturation became 90% for 5 minutes. You decided to shift to simple mask. What is the best flow rate to start with? And why? A. Simple mask at 5 L/min B. Simple mask at 6 L/ min C. Simple mask at 7 L/min D. Simple mask at 10 L/min By Dr. Fekri Eltahir Abdalla
  22. 22. Case 2  A known asthmatic young man resented with acute SOB and he was found tachypneic (RR=35), tachycardic (HR = 120) and desaturated (SPO2 = 88%). You found diffuse wheeze at auscultation with decreased air entry bilaterally. You planned to give him oxygen plus nebulized Ventolin initially, but he still continued desating while on oxygen-powered nebulized therapy. Your best action of management then is: A. Shift to non rebreathing mask and continue nebulization. B. Intubate the patient immediately for acute severe asthma. C. Initiate non invasive mechanical ventilation and delay Ventolin therapy. D. Put him on nasal prong plus continue nebulized Ventolin with simple mask at maximum flow rate. By Dr. Fekri Eltahir Abdalla
  23. 23. Mask plus reservoir By Dr. Fekri Eltahir Abdalla Simple mask Partial rebreathing mask Non rebreathing mask
  24. 24. The device Characteristics Advantages Disadvantages Simple mask 5 – 10 L/min FiO2 ( 40 – 60%) Mask – no reservoir Nebulizer or venture port Accepted FiO2 Considerable air mixing - No use of mouth Partial mask 5 to max to Keep bag inflated Simple mask + reservoir Higher FiO2 FiO2 (up to 80 %) Less room air mixing - no use of nebulizer or venturi Non rebreathing 5 to max to keep bag inflated Simple mask + reservoir + one way valve Highest FiO2 Negligible room air mixing FiO2 (up to 95%) No use of mouth, venture or nebulizer By Dr. Fekri Eltahir Abdalla Partial rebreathing/ non rebreathing
  25. 25. Case 3  A known COPD patient on home oxygen (2 L per nasal prong) presented with acute exacerbation. At triage was found tachypneic and desat (SPO2 75%). The nurse started 4L O2 by nasal prong and you add non oxygen power nebulized Ventolin. After 20 min, saturation became 82%. You plan to continue nebulization plus requesting ABG. What is the best O2 delivery device for this patient at this level (ABG pending!)? A. Simple mask at 5 L/min B. Adjustable venture mask. C. CPAP D. Intubation and mechanical ventilation By Dr. Fekri Eltahir Abdalla
  26. 26. Venturi mask Characteristics Advantages Disadvantages High flow device Controlled FiO2 Limited low FiO2 Room air mixing Suitable for chronic CO2 retention Ignores patient O2 demand Adjustable valve Can use nebulizer Use simple mask or CPAP By Dr. Fekri Eltahir Abdalla
  27. 27. Venturi mask By Dr. Fekri Eltahir Abdalla
  28. 28. Venturi mask By Dr. Fekri Eltahir Abdalla
  29. 29. Positive pressure ventilation Indications Advantages Disadvantages Hypoxia despite full O2 Hypoventilation CO2 retention Decrease work of breathing Unprotected airway Avoid intubation Gastric insufflation Requirements Improve oxygenation Slow correction (time) Conscious – cooperative – vitally stable – airway protected by their own – reversible cause Improve ventilation Tight mask problems Decrease venous return By Dr. Fekri Eltahir Abdalla
  30. 30. NIV Monitoring Response Physiological a) Continuous oximetry b) Exhaled tidal volume c) ABG should be obtained with 1 hour and, as necessary, at 2 to 6 hour intervals. Objective a) Respiratory rate b) blood pressure c) pulse rate Subjective a) dyspnea b) comfort c) mental alertness By Dr. Fekri Eltahir Abdalla
  31. 31. NIV Monitoring Mask Fit, Comfort, Air leak, Secretions, Skin necrosis Respiratory muscle unloading Accessory muscle activity, paradoxical abdominal motion Abdomen Gastric distension By Dr. Fekri Eltahir Abdalla
  32. 32. NIV Discontinue  Inability to tolerate the mask because of discomfort or pain  Inability to improve gas exchange or dyspnea  Need for endotracheal intubation to manage secretions or protect airway  Hemodynamic instability  ECG – ischemia/arrhythmia  Failure to improve mental status in those with CO2 narcosis. By Dr. Fekri Eltahir Abdalla
  33. 33. Positive pressure ventilation By Dr. Fekri Eltahir Abdalla Less dead space. Claustrophobia Can use mouth Dyspnic are mouth breather. More dead space. Clustrophobia
  34. 34. Positive pressure ventilation By Dr. Fekri Eltahir Abdalla Method of NIV CPAP BiPAP Name Continuous Positive Airway Pressure Bilevel Positive Airway Pressure Descriptions Preset ePAP (PEEP) Pt initiate breathing ePAP ( 4 to 20 cmH2O) Open more alveoli (recruitment) Preset iPAP/ ePAP Pt initiate breathing Can set backup RR iPAP (8 – 20 cmH2O) ePAP (4 – 10 cm H2O) Indications COPD – APE(decrease venous return) – sleep apnea Acute hypercapnia – cardiogenic APE – resp muscle fatigue/paralysis
  35. 35. Positive pressure ventilation By Dr. Fekri Eltahir Abdalla
  36. 36. Indications Advantages Disadvantages Severe hypoventilation RR < 8/ min Simple technique (learning) Uncontrolled hyperventilation Gastric – lung - ABG Apnea Available Temporary Cardiac arrest Positive pressure/ PEEP Assist ventilation/O2 MOANS/ open airway Effectiveness? Preoxygenation in RSI High FiO2 100% Utilize medical personnel Positive pressure ventilation By Dr. Fekri Eltahir Abdalla
  37. 37. Case 4  While you are treating COPD patient with venturi mask plus nebulized SABA, he is not improving and continued desating after 1 hour of your management and his ABG showed (pH 7.20, pCO2 65 mmHg, pO2 50 mmHg). His vital signs: HR 125, RR 36, BP 85/54, GCS 14/15. what is your best next action of management? A. Shift to CPAP immediately. B. Shift to BiPAP immediately. C. Intubation and mechanical ventilation. D. Give IV fluids and continue same plan. By Dr. Fekri Eltahir Abdalla
  38. 38. Summary  O2 is a drug, so it must be used judiciously.  You should set your targets:  Before you move to mechanical ventilation, consider to make the maximum use of simple devices available.  It is important to keep in mind each device capabilities and limitations.  Monitoring during O2 therapy is vital.  NIV is an option but patient should meet the criteria for its application. By Dr. Fekri Eltahir Abdalla
  39. 39. Before The end By Dr. Fekri Eltahir Abdalla
  40. 40. Questions? By Dr. Fekri Eltahir Abdalla

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