The document discusses SARS-CoV-2, the virus that causes COVID-19, and how it infects and travels through the respiratory tract. It outlines how the virus enters the body through mucous membranes and hijacks cells to replicate. It then describes various oxygen therapy options for COVID-19 patients, including nasal cannulas, masks, hoods, tents and concentrators. Risks of too much or too little oxygen are mentioned.

2. SARS-COV-2, the virus that causes COVID-19, is part of
the coronavirus family.
When the virus gets in your body, it comes into contact
with the mucous membranes that line your nose, mouth
and eyes. The virus enters a healthy call and uses the cell
to make new virus parts. It multiplies and the new virus
infect near by cells.
Think of your respiratory tract as an upside tree. The
trunk is your trachea or windpipe. It splits into smaller
smaller branches in your lungs.

3. The New coronavirus can infect the upper or lower
part of your respiratory tract. It travels down your
airways. The lining can become irritated and
inflamed.
In some cases, the infection can reach all the way
down in to your alveoli.

5.  Each covid-19 patient is different from the rest. Among
those who need oxygen supplement, someway require one
to two litres of oxygen per minutes.
 Factoring in wastage in oxygen supply and utilisation
capacity of the lungs at the moment, this requirement
may translate into three to four litres of medical oxygen
per minute.
 Fewer number of Covid-19 patients require usage of high
flow nasal cannula (HNFC) . Their oxygen requirement could be
60 lit /min or 3600 lit/hour .In some cases, the oxygen
requirement need can go up to 86000 lit/day per patient.

6. The optimal oxygen saturation (spO2) in adults with covid
-19 is uncertain.
However, a target spO2 of 92% to 96% seems logical
considering that indirect evidence from experience in
patients without covid-19 suggest that an spO2 92% or
96% may be harmful.

7.  Oxygen therapy is a key treatment in respiratory care.
 The air that we breathe contain approximately 21%
oxygen.
 Oxygen therapy is the administration of oxygen at a
concentration of pressure greater than that found in the
environmental atmosphere.
 Oxygen treatment is principally for low blood oxygen.
 This is usually assessed by pulse oximetry, which assesses the
amount of hemoglobin that is combined with oxygen in the
arterial blood
 This measurement only really works well when there is a full,
regular pulse, therefore where the digit is warm and well
perfused and the heart rhythm is regular.

8.  Cold digits, AF, other causes of poor circulation may give a low
reading. However, if in doubt, 4 l/m O2 will not do any harm to
almost any adult (seek medical advice in chronic lung disease,
where chronic means of long duration (from Chronos, god of
time)).
 There is much talk of hyperbaric oxygen at the moment. This is giving
added oxygen through a mask to a person in a pressurized tank
 The oxygen in the inhaled air will be much above normal, and there
will result from that a small rise in oxygen content in the blood, even
in those with normal heart and lungs, from oxygen dissolved in
plasma: there may be a substantial rise in oxygen partial pressure in
the blood.

10.  Oxygen gas
 Liquid oxygen
 Oxygen concentrator
 Hyperbaric oxygen therapy

12.  Nasal Cannula
 Face Mask
Simple Mask
Partial Re-Breather Mask
Non-Re-Breather Mask
Venturi Mask
 Oxygen Hood
 Oxygen Tent
 AMBU Bag
 Tracheostomy Collar
 T-piece

13.  It is a disposal, plastic device with two protruding prongs
 for insertion into the nostrills, connected to an oxygen
source.
 used for low medium concentrations of oxygen( 24-44%).
 It carries 1-3 litres of oxygen per minute.
 Flow rates of up to 60 litres of air/oxygen per minute can be
delivered through wider bore humidified nasal cannula.

14. Simple oxygen mask
 Transparent mask provided with the side holes
 Reservoir capacity – 100-250ml
 Different oxygen flow rates result in a highly variable and
unpredictable FiO2
 4L/min of oxygen flow delivers an FiO2 an about 0.35-0.4
providing there is a respiratory pattern
 Flow rates greater than 8 L/min do not increase FiO2

15. Advantage
 Less expensive
 Can be used in mouth breathers
Disadvantage
 Require tight seal
 Uncomfortable
 Do not deliver high FiO2
 Chances of re-breathing are high
 Difficult to keep in position for long time

16.  Mask with reservoir bag of capacity 1L
 Oxygen flows directly into the reservoir bag, which fills
during exhalation
 Designed in such a way that it captures exhaled gases
from initial part of expiration from the dead spaces
 Useful in situations where supplies are limited
 Deliver an FiO2 between 0.6 to 0.8
 Flow rate must be sufficient to keep bag 1/3 to ½ inflated
all times

17.  Provided with one way halve between mask and bag
 FiO2 of 95% can be achieved with an oxygen flow rates of 10 to
15 L/min
 Ideally NRM should not allow entrainment of air, but because of
safety concerns one of the two exhalation ports is not provided
with valve
 Higher oxygen supply rates are required

18.  Oxygen hoods are cylinders or boxes that enclose an infant’s or
small child’s head
 Oxygen enters through a gas inlet port, and exhaled gas leaves
primarily through the opening for the neck
 Hoods provide up to 80% to 90% oxygen, good humidification,
and controlled temperature.
 They allow easy access to the child for other care.

19.  Oxygen tents are most often used when a patient suffers from
respiratory problems. Carbon monoxide poisoning or a disease
like pneumonia can be helped with the oxygen tent.
 The tent covers the entire head and upper body, and oxygen is
pumped in from a tank.
 The tent is usually a dome-shaped hood over a hospital bed
 The tent seals out the regular atmosphere so that the patient can
breathe only the oxygen-rich air that is forced in at the top of the
tent. The tent is also equipped with a pump to keep the air
circulating.
 The gas inside the tent has a higher percentage of oxygen than
normally found in air

21.  A bag valve mask (BVM), sometimes known by the proprietary
name Ambu bag or generically as a manual resuscitator or "self-
inflating bag", is a hand-held device commonly used to provide
positive pressure ventilation to patients who are not breathing or
not breathing adequately.
 The Ambu device can provide 100% oxygen from its rear part
even at low flow rates and 100% oxygen during active ventilation
provided at least 10 L/min oxygen is used.

22.  A tracheostomy (trach) tube is a curved tube that is
inserted into a tracheostomy stoma (the hole made in the
neck and windpipe (Trachea).
 A commonly used tracheostomy tube consists of three
parts: outer cannula with flange (neck plate), inner cannula,
and an obturator.
 The outer cannula is the outer tube that holds the
tracheostomy open. A neck plate extends from the sides of
the outer tube and has holes to attach cloth ties or velcro
strap around the neck.

23.  Used on end of ET tube when weaning from ventilator
 Provides good humidity
 Provides good FiO2

24.  Two types of oxygen concentrators namely continuous flow and
pulse dose are available to us in the market.
 While a continuous flow oxygen concentrator provides the same
flow of oxygen in a minute until its been turned off, pulse dose
identifies the patient's breathing pattern and gives out oxygen
when it detects inhalation.
 Therefore, the oxygen dispensed by pulse units cannot be
measured the same as continuous flow oxygen concentrators, as
they do not produce constant oxygen for one minute.
 As per reports, 1 liter of oxygen can raise the lung capacity of a
patient to 24%, whereas 2 liters can increase it to 28% and so on.
However, it can be regulated as per the need.

25.  Oxygen concentrators are portable and easiest alternatives to
massive oxygen cylinders. However, they can only provide 5-10
litres of oxygen per minute, which may not be enough for severe
patients
 Only people down with mild and moderate symptoms are
advised to use oxygen concentrators.
 oxygen concentrators can be easily carried from one place to
another and do not need refilling each time. It only needs a
source of power to draw in ambient air.
 Oxygen concentrators draw in the atmospheric air and purifies it
of the nitrogen and other gases, providing pure oxygen to
patients suffering with low oxygen levels.

26.  To determine whether a person will benefit from oxygen therapy,
doctors test the amount of oxygen in their arterial blood.
 Another way to check is using a pulse oximeter that indirectly
measures oxygen levels, or saturation, without requiring a blood
sample. The pulse oximeter clips onto a person’s body part, like a
finger.
 Low levels mean that a person may be a good candidate for
supplemental oxygen.
 Normal levels of arterial blood oxygen are between 75 and 100
mmHg (millimeters of mercury). An oxygen level of 60 mmHg or
lower indicates the need for supplemental oxygen. Too much oxygen
can be dangerous as well, and can damage the cells in your lungs.
Your oxygen level should not go above 110 mmHg.

27.  Have certain types of lung diseases, because
of an increased risk for a collapsed lung
 Have a collapsed lung
 Have a cold or a fever
 Have had recent ear surgery or injury
 Do not like small enclosed spaces
(claustrophobia)

28. BY PATIENT-
 Variation in, or lack of, oxygen saturation
testing practices
 Wide variety of oxygen equipment and
patient unawareness of their choices
 Absence of safeguards to protect the patient
if their DME goes out of business—including
short notice, no written notice, no
assistance from the closing DME

29. BY OTHERS-
 Lack of collaborative clinical guidelines that
elucidate the elements of an optimal
prescription causing delivery delays, or
finding that the prescribed oxygen system is
not available
 Due to improper regulating of flow of liquid
oxygen in mask it lead to wastage of oxygen
in starting of applying mask
 Limited use of therapeutic patient education:
providing information alone is not sufficient

30.  Lung damage
 Fluid buildup or bursting (rupture) of the
middle ear
 Sinus damage
 Changes in vision, causing nearsightedness,
or myopia
 Oxygen poisoning, which can cause lung
failure, fluid in the lungs, or seizures

31.  Keep the oxygen at least 3 metres from any open flame or heat
source, such as candles or a gas stove, or from anything that
could cause a spark.
 Do not smoke or let anyone else smoke near the oxygen
equipment.
 Avoid using anything flammable near the oxygen, including
petrol,
cleaning fluid, and aerosol cans or sprays such as fresheners or
hairspray.
 Do not allow alcoholic solutions, oil or grease to come into
contact with oxygen supply devices. This includes petroleum jelly.

32.  As the oxygen concentrator becomes hot when in use,
locate it in a well-ventilated area, away from curtains or
drapes.
 Have your oxygen concentrator inspected and serviced
regularly according to the supplier’s instructions.
 Store oxygen cylinders in an upright secure position in a
well-ventilated area away from any open flame, heat
source or direct sunlight. Do not cover with cloth or plastic.
 Handle oxygen equipment with care to avoid damaging
cylinders.
 Secure and transport oxygen cylinders correctly.

33. Thank you