This document discusses oxygen therapy and oxygen toxicity. It aims to provide guidelines for oxygen therapy including indications, goals, delivery methods and their advantages/disadvantages. Prolonged high concentration oxygen can cause pulmonary toxicity similar to ARDS. The optimal oxygen concentration is the lowest that maintains tissue oxygenation below 60% FIO2 to avoid toxicity. Measures like mechanical ventilation and antioxidants can help prevent toxicity from prolonged high concentration oxygen.
oxygen is a medication. oxygen therapy must be known to all health professionals for optimum management of patient and optimum use of resourses. even more oxygen can cause oxygen toxicity and can harm the patient in many ways. There are various methods for giving oxygen,varieties of face masks, cylinders. also there is criteria when to give oxygen ,how to give oxygen,what are the benefits and mechanism of oxygen therapy.
oxygen is a medication. oxygen therapy must be known to all health professionals for optimum management of patient and optimum use of resourses. even more oxygen can cause oxygen toxicity and can harm the patient in many ways. There are various methods for giving oxygen,varieties of face masks, cylinders. also there is criteria when to give oxygen ,how to give oxygen,what are the benefits and mechanism of oxygen therapy.
Oxygen therapy is an integral part of the treatment of critically ill patients. Maintenance of adequate
oxygen delivery to vital organs often requires the administration of supplemental oxygen,
sometimes at high concentrations. Although oxygen therapy is lifesaving, it may be associated
with deleterious effects when administered for prolonged periods at high concentrations.
MR. MOHAMMAD TALAL AL JOHANY
RESPIRATORY THERAPIST
Meqaat Hospital Madina
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Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
5. Aim of oxygen therapy
To restore tissue oxygen tension towards
normal, a partial pressure of 97 mmHg
is required at the cellular mitochondria
to maintain metabolism.
6. Goal of O2 therapy : Pao2
Virtually every patient in ICU receives supplementary
o2 , surprisingly there are few guidelines for o2 therapy.
American College of Chest Physicians and National Heart
Lung and Blood Institute recommendations for instituting
oxygen therapy & British thoracic socity.
1. Cardiac and respiratory arrest.
2. Hypoxemia (PaO2<7.8 kPa, SaO2<90%).
3. Hypotension (systolic blood pressure <100 mm Hg).
4. Low cardiac output and metabolic acidosis.
(bicarbonate<18 mmol/l).
5. Respiratory distress (respiratory rate >24/min).
7. GAS EXCHANGE
alveolar Po2 never reach the inspired level
because of residual air in alveoli at the end of
exhalation.
When oxygen tension drops because of disease
or pulmonary infiltrates, flow can be
maintained by increasing pao2 with oxygen
supplement.
8. O2 160 O2 116
CO2 0.3 CO2 32
H2O 47 H2 O 47
N2 596 N2 565
Dead Space
Alveoli O2 100
CO2 40
H2 O 47
N2 573
VEIN ARTERY
O2 40 O2 95
CO2 46 CO2 40
H2O 47 H2O 47
N2 573 N2 573
CAPILLARY
O2 40
CO2 46
H2O 47
N2 573
9. OXYGEN CONTENT =
(1.3XHBXSaO2)+(0.003XPaO2)ml/100ml
OXYGEN DELIVERY =
Q X oxygen content ml/mint.
( hemodynamics are very important in respiratory
failure)
OXYGEN FLUX:
O2 available in the body= 5000x19.8 = 990ml/min.
100
normal O2 consumption 250 ml/min
Large reserve 740ml/min is available.
During exercise COP can increase up to 20L/min,
If more than this oxygen debt by anaerobic
metabolism.
11. Hypoxia: Is the O2 deficiency at the tissue
level.
Hypoxemia: is the O2 deficiency on the blood
PaO2 < 60mmHg
Cyanosis: is the bluish discoloration of the
tissue can be detected when reduced Hb 5g%
or more. It is often absent in hypoxemic
patient with anaemia and easy detected in
polycythemia.
12. Hypoxic Hypoxia :-
Pa02 ,low as 02 prevented to reach pulmonary capillaries.
Causes: a) lung Failure e.g. pulmonary fibrosis,
ventilation perfusion mismatch.
b) Ventilatory Failure e.g. fatigue,
depression of RC e.g. narcotics,
Pneumothorax , bronchial obstruction.
Anaemic Hypoxia -:
Decrease 02 carrying capacity (low Hb).
13. Cont.
Stagnant hypoxia - :
* Low COP: Low circulation is a problem in organ
such as kidney, heart, during shock. Liver and
brain are damage by stagnant hypoxia in CCF.
* Shock lung can developed in prolonged
circulatory collapse, surfactant production ↓ in un-
perfuse area.
* Local due to vascular occlusion.
Histotoxic hypoxia -:
Tissue unable to utilized the normal supplement of 02.
e.g. cyanide poisoning, septicemia.
14.
15. Effect of hypoxia
1. Respiratory System :-
Dyspnea is by definition breathing in which the
subject is conscious of his shortness of breath.
Hyperpnoea general term for ↑ in rate or dept of
breathing.
Tachypnea: rapid shallow breathing
Tachypnea is due to reflex stimulation of the
respiratory center by chemoreceptor's in AO & carotid
bodies. Which react to lower O2 tension.
16. Cont.
2. Cardiovascular System:-
Coronary, systemic, and cerebral vasodilatation.
Pulmonary vasoconstriction.
↑ COP, ↑ HR, and ↑ stroke volume.
Arterial pressure ↓ in hypoxia but ↑ if hypercapnia co-
exist.
In severe hypoxia cardiovascular collapse occurs.
17. Cont.
3. Central Nervous System:-
The nervous tissues is more susceptible to
hypoxia than any tissue of the body. Blood
flow ↑ → cerebral edema.
↑ CSF pressure.
Less hypoxia cause drowsiness,
disorientation, Headache.
Hypotension greatly magnifies the brain
damaging effect of hypoxia.
18. INDICATION OF 0 2 THERAPY
Despite the fact that 0 2
inhalation is a therapeutic
intervention designed to correct
tissue hypoxia, 0 2 administration
seems to be more of a knee jerk
response to the presence of life
threatening conditions.
this is supported by recent survey
showing that over 50% of
hospitalized patient were
19. TO WHOM I WILL ORDER 02
SUPPLEMENT:
1. Respiratory Failure.
2. Acute MI.
3. Bronchial Asthma.
4. Sickle Cells Crises.
5. Carbon Monoxide Poisoning, NRM or HCM.
6. Gas Gangrene , NRM or HCM.
7. Cluster Headache, NRM or HCM.
8. Pre Operative & Post Operative.
9. Hyperthermia.
20. To whom I will order O 2
1. Respiratory failure
a. Hypercapnic Respiratory failure,
in this type PaO2 <55mmHg & PaCO2 > 46mmHg
Goal of therapy :
I. To ↑PaO2 > 60mmHg.
II. To Achieved SaO2 88 to 90%.
III. To prevent vasoconstrictive effect of pulmonary
hypertension and corpulmonal.
Therefore low flow therapy must be used. Consequently care
should be taken to avoid the administration of excessively
rich O2 mixture.
Devices used Venturi mask with FIO2 22-28% if Pa02 still < 55 after
30 min administer of progressive increment of inspired O2 is undertaken.
Blood gas analysis measurement every 30 min in the first 1 - 3 hour.
If Pa02 fail to increase and mental status change, intubation and
mechanical ventilation indicated.
21. Cont.
B. Non hypercapnic respiratory failure.
Goal ↑PaO2 > 60mmHg.
Device use Venturi mask with 50% FIO2 if failed to
give saturation 90% and PaO2 >60 this mean the
patient had severe cardiogenic, pulmonary edema,
ARDS.
Then NRM to be used as it give FIO2 90%. CXR
must be done and show diffused infiltration so
patient must be intubated, MV with PEEP.
22. Cont
2. Continuous O2 Therapy:
Significantly prolonged and improved the
quality of life in hypoxemic patient with
COPD.
indicated: Patient with:
1. PaO2 55mmHg:
2. Hb > 55 %.
3. With Peripheral edema.
4. ECG show P Pulmonale.
23. Bronchial Asthma
In ER in acute asthmatic attack
High flow 6 to 8 L/min must be give.
AIM: to keep SaO2 > 90%.
Criteria to admission to ICU according to national
protocol for management of asthma 2010:
1) PaO2 < 60mmHg.
2) PaCO2 > 45 mmHg.
3) PEF < 30%.
In ICU Venturi mask 50 % used if failed CPAP for 1
hour if no response intubation MV, CXR must be
done to clear out pneumothorax.
25. Oxygen Delivery System
O2 devices are classified into 2
types:-
1. Low Flow System which deliver
variable FIO2. e.g. N/C, SFM, PRM,
NRM.
2. High flow system deliver constant
FIO2. e.g. Venturi Mask, CPAP Mask,
Face Tent, T-Piece, Ventilator Machine.
27. Low flow O2 Delivery System
Device Advantages Dis-advantages
Nasal Capacity 50ml – 1/3 Not give FIO2 > 40%
Cannula Anatomic Dead Space . Not use with nasal block
Safe, Comfortable or polyp.
Simple Face Capacity 100 -200ml Interfere with eating &
Mask Give 5-10L/min. drink, discomfort to the
patient & impractical for
Allow patient to breath
air if O2 source fails. long term therapy.
Non- Capacity 600 -1L Tight, sealed difficult to
Rebreathing O2 con 60-90% effective maintain in its position
Mask in short term therapy.
30. High Flow O2 delivery System
Device Advantages Dis-advantages
Venturi Accurate concentration of O2 concentration
Mask O2 given to patient. altered if not fit.
Humidity & aerosol can be Uncomfortable for the
added. patient.
CPAP Non invasively improved Uncomfortable may
arterial oxygenation by ↑ need sedation high
FRC. risk for aspiration if
patient vomits.
Face Tent Administer high humidity. Do not deliver
Function as high flow accurate O2
system when attached to concentration
Venturi. Used in paediatric
& burn patients.
31. Summary in O2 Delivery
System
That is Mean:-
When High FIO2 required CPAP, IPPV
When controlled FIO2required Venturi Mask
When low FIO2 required N/C SFM
When patient uncooperative Face Tent ,
IPPV may consider.
Humidification is necessary:
Monitoring by blood gas measurement and pulse
Oximeter.
33. Adverse Effect Of High 02 Concentration
Effect of inhalation of 100% 02:
1. N2 eliminated from lungs within 2 min.
2. ↓ reduced HB therefore interfere with C02 transportation.
3. ↓ RR secondary to removal of stimulatory effect of
chemoreceptor.
4. ↓ HR, ↑BP, cerebral & coronary vasoconstriction, but
pulmonary vasodilatation.
5. Prolonged administration of 02 may interfere with red cell
formation.
6. Retrolental fibroplesia:
Formation of fibro vascular membrane post. To lenses, in premature
babies.
7. Fire hazard.
34. When stopping O2 treatment
1. While patient breathing room air
PaO2 >65mmHg & SaO2 >90%.
2. In patient without arterial hypoxemia
but at risk of tissue hypoxia. O2 should
be stop when acid base state & clinical
assessment of vital organ functions are
consistent with resolution of tissue
hypoxia.
35. Titrating Oxygen up and down
using the mask escalator
This table below shows APPROXIMATE conversion values.
Venturi 24% (blue) 2-4l/min OR Nasal specs 1L
Venturi 28% (white) 4-6 l/min OR Nasal specs 2L
Venturi 35% (yellow) 8-10l/min OR Nasal spec 4L
Venturi 40% (red)10-12l/min OR Simple face mask 5-6L/min
Venturi 60% (green) 15l/min OR Simple face mask 7-10L/min
Reservoir mask at 15L oxygen flow
If reservoir mask is required, seek senior medical input immediately
36. Oxygen prescribing Summary
- Oxygen is a life saving drug
- Oxygen must be prescribed
- Doctors will prescribe Target saturation
- Prescription will be written on Oxygen section on drug
chart
- Nurses will choose mask and &/flow rate to achieve Target
Saturation
- Nurses can titrate Oxygen up & down & record on obs
chart
- Nurses can wean patients off oxygen
- Oxygen must be monitored minimum four hourly
- Nurses must sign drug chart every drug round
37. Pulmonary Oxygen Toxicity :-
Inhalation of pure O2 can produce a progressive lung injury
similar to ARDS.
ARDS is a result of inflammatory cell injury, O2 metabolized
play and important rule in the damaging effect of
inflammation.
In a study done, 10 healthy volunteers inhaled 100% O2 for 6-
12 hours. Results in a tracheobronchitis & a ↓in vital capacity.
Acute O2 poisoning manifested with convulsion not occur
except with hyperbaric O2.
Chronic poisoning may occur with O2 concentration above
60% for prolonged time, may be due to reactivation of
surfactant and damage to epithelium.
38. Oxygen Toxicity
II Safe Versus Toxic FIO2:-
Observed that O2 inhaled dose not ↓VC if FIO2 <
60%. An FIO2 60% was established as the threshold
FIO2 separating safe for toxic level of inhaled
oxygen.
The consensus is that inhalation of a gas mixture
with an FIO2 > 60% for longer than 48 hours is a
toxic exposure to inhaled O2.
If FIO2 > 60% required for longer than few days
other measures should be instituted such as
mechanical ventilation & PEEP.
39. Oxygen Toxicity
Optimal FIO2:-
The recommendation of a universal FIO 2 threshold
separating safe from toxic O2. Inhalation is inappropriate
because it neglects the contribution of endogenous
antioxidant to the risk of O2 toxicity.
If antioxidant become depleted, O2 toxicity occur at FIO2
< 60%. Antioxidant ↓ is more common in patient in ICU
with prolonged stay.
▲ The optimal FIO2 for safe O2 inhalation is
the lowest tolerable FIO2 below 60%.
40. Preventive Measures for O2 Toxicity
GOALS ACTION
Limit O2 Use supplemental O2 only for:-
inhalation Arterial hypoxemia
Indirect evidence of tissue dysoxia.
High risk for tissue dysoxia.
Limit the If FIO2 > 60% for 48h, consider mechanical
FIO2 ventilation or PEEP.
Support Satisfy the RDA for selenium :-
Antioxidant If high risk of O2 toxicity, evaluate selenium &
If
Protection vit. E status periodically.
41. Oxygen prescription chart
Model for oxygen section in hospital prescription charts
DRUG OXYGEN
(Refer To Trust Oxygen Policy)
Circle target oxygen saturation
88-92% 94-98% Other___
Starting device/flow rate________ PHAR
M
PRN / Continuous
Tick if saturation not indicated
(Saturation is indicated in almost all
cases except for palliative terminal
care)
SIGNATURE / PRINT NAME DATE
ddmm
yy
* Saturation is indicated in almost all cases except for palliative terminal care
42. Generally ^_^
O2 is a drug. A Dr.’s order is required to
initiate O2 tx except in emergency
situations
Order should include specific SpO2 or
O2 flow rate/ FiO2
O2 can be started without an order if
hypoxia is suspected. Dr. must be
contacted ASAP
43. Standard wall set-up for O2 requires
humidification (bubble humidifier/ cold neb)
Assess fluid level in humidifier with each RN
assessment. Change 3x/week + prn
Portable O2 set-up: DO NOT incorporate
humidity (risk of water spilling into delivery
device)
44. Monitoring
O2 to be treated as a drug so need to
ensure the rights:
Patient
Drug (O2)
Route (device)
Dose (flow/FiO2)
Documentation
Reason
45. Safe Handling of O2
Cylinders should be placed in secure holder
to prevent tipping/ falling when not in use
When transporting pt on O2, cylinder must
be secured in a carrier attached to bed,
stretchers , wheelchair or crib
46. Transporting pts on O2
Ensure adequate O2 supply in tank
for anticipated length of time
Switch to wall O2 if available at
destination and TURN TANK OFF!
May need to bring 2 tanks for pt’s
requiring high flow
Change cylinders at 500 psi
47. Conclusion
Oxygen is a life saving treatment. It
is widely used, should be prescribed
in written (with the required flow
rate, method of delivery), clearly and
specific. Careful monitoring during
Oxygen therapy is essential.