Oxygen for the Critically Ill Oxygen for the Acutely unwell Oxygen for COPD Patients
2 Important Messages Oxygen is a treatment for Hypoxia not Breathlessness Oxygen saturations should be checked and recorded along with the concentration of inspired oxygen
All All critically ill patients receive high flow Oxygen 15L/min via reservoir mask Critically Ill
Cardiac arrest or resuscitation Anaphylaxis ShockHead Injury Sepsis Major Pulmonary haemorrhage Trauma Carbon Monoxide Poisoning When stabilised manage as per Guidelines for the acutely unwell Critically Ill?
Acutely Unwell? Acute AsthmaPulmonary Embolism PneumoniaPleural Effusions Heart FailurePneumothorax Examples:- If unsure give 15L via reservoir mask and complete initial assessment.
Need to achieve saturations 94-98% Give whatever is needed to achieve these saturations If Sats <85% give 15L/min via reservoir mask Otherwise Start with 10L/min via Hudson mask (but reassess and give more if needed) Acutely Unwell
Remember If in doubt… Give 15L via Reservoir mask And complete initial assessment
(And others at risk of retaining CO2) Need to achieve saturations of 88-92% Give 28% Oxygen via venturi mask (If unable to achieve desired saturations try higher concentration Venturi masks) Perform Arterial Blood Gas Perform Blood gas analysis 30-60 mins after every change in oxygen concentration COPD Patients
If pCO 2 is <6.0kPa It is safe to aim for saturations of 94-98% If developing hypercapnia (pCO 2 >6KPa) along with ongoing hypoxia – NOTDo NOT Decrease Oxygen! Consider need for assisted ventilation – NIV or Intubation. ABG in COPD Patients
Oxygen Guidelines More detailed guidance from the British Thoracic Society www.brit-thoracic.org.uk/ NHS Tayside Oxygen Prescribing chart is derived From these Guidelines