1. Program: Respiratory Therapy
Course: Applied Respiratory Therapeutics
Lesson: Medical Gas Therapy
Why do we give patients Oxygen?

2. Lesson: Medical Gas Therapy
Major Student Performance Objective 1-Lecture
Administer safe oxygen therapy to the patient.
Supporting Student Performance Objectives:
Discuss the three indications for oxygen.
Discuss the four hazards of oxygen therapy and how to avoid them.
List the rules for administration of oxygen.
Discuss hyperbaric O2 therapy.
Discuss other medical gas therapies.

3. Lesson: Medical Gas Therapy
Major Student Performance Objective 1 - Laboratory
Safely administer oxygen.
Supporting Student Performance Objectives:
Correctly assemble, test for function, safely apply, and troubleshoot the following:
Nasal cannula - Venturi oxygen device
Simple oxygen mask - Oxygen tent
Partial rebreathing oxygen - Croupette
mask
Non-breathing oxygen mask - Isolette
Demonstrate how to analyze F1O2
Calibrate the oxygen - Adjust delivery device analyzer as appropriate
Analyze at an - Document the oxygen
appropriate position concentration

4. Indications for Oxygen Therapy
Lesson: Medical Gas Therapy
Indications for Oxygen Therapy
Treat Hypoxemia
Decrease the work of breathing
Decrease myocardial work

5. Hazards of Oxygen Therapy
Lesson: Medical Gas Therapy
Hazards of Oxygen Therapy
Oxygen Toxicity
Absorption Atelectasis
Oxygen Induced Hypoventilation
Retrolental Fibroplasia – RLF
ROP – retinopathy of prematurity

6. Guidelines for Oxygen Administration
Lesson: Medical Gas Therapy
Guidelines for Oxygen Administration
Oxygen concentrations less than 40% rarely cause oxygen toxicity.
100% oxygen has not been shown to cause oxygen toxicity when used less than 24 hours.
100% oxygen is not contraindicated for brief periods in an emergency.
Shapiro: “To allow a patient to be exposed to dangerous levels of hypoxia for fear of oxygen toxicity is intolerable.”
Use minimal O2 concentrations to achieve a state of no hypoxia.
Monitor patients closely.

7. Indications for Low Flow Devices
Lesson: Medical Gas Therapy
Indications for Low Flow Devices
Patient’s VT ml
Respiratory rate lower than 25 BPM
Consistent, regular, ventilatory patterns

8. Lesson: Medical Gas Therapy
Low Flow Systems
FIO2 will vary according to patient’s ventilatory pattern.
Factors influencing FIO2:
1. Patient’s ventilatory pattern
2. Flow of gas
3. Reservoir
As VT increases, FIO2 decreases due to more entrainment of room air.
As VT decreases, FIO2 increases due to less entrainment of room air.
Respiratory rate will effect system if there is not adequate time for reservoir refill.
FIO2 is:
1. Unpredictable
2. For the most part immeasurable
3. May vary from minute to minute

9. Lesson: Medical Gas Therapy
Low Flow Devices
Nasal Cannula
Nasal Catheter
Simple O2 Mask
Partial Rebreather Mask
Non-Rebreather Mask

10. Lesson: Medical Gas Therapy
High Flow Systems
Meets all patient’s demands for gas delivered.
Total system output must be at least 3 times patient’s minute volume.
Consistent, predictable, measurable FIO2
Criteria for high flow system:
Systems - Venturi Masks

11. Lesson: Medical Gas Therapy
Use of Analyzers
To analyze high flow systems.
Patients may not receive FIO2 analyzed if flow is not adequate.
Used in measuring mechanical ventilation.

12. Types of Oxygen Analyzers
Lesson: Medical Gas Therapy
Types of Oxygen Analyzers
Paramagnetic or Physical Analyzers
Electrical, Thermal Conductivity, Wheatstone Bridge
Chemical
Electrochemical Analyzers, Polarographic Principle, Clark Electrode, and Galvanic

13. Lesson: Medical Gas Therapy
Comparison of Oxygen Analyzers
Physical (paramagnetic)
Electrical (thermal conduction)
Electrochemical (polarographic)
Electrochemical
(galvanic cell)
Parameter measured Partial Oxygen Partial Partial
Pressure Concentration Pressure Pressure
Accurate with other
gases? Yes Oxygen and Yes Yes
Nitrogen Only
Sampling technique Intermittent Intermittent Continuous Continuous
Static Sample Static Sample Dynamic Dynamic
Use with flammable
gases? Yes No Yes Yes
Oxygen consumption No No Yes Yes

14. Lesson: Medical Gas Therapy
Calibration
Greater than 60% - Calibrate last to 100%
Less than 60% -
Calibrate last to 21%
Should be calibrated
once per shift
Possible sources of error:
Weak batteries
Torn, wet, or leaky membranes
Positive pressure (PEEP or IPPB)
Altitude

15. Lesson: Medical Gas Therapy
Patient Cases
Patient 1: I.M. Quick
Patient:
I.M. Quick, a forty-nine year-old male. Admitted with an exacerbation COPD. Patient is alert but slightly confused.
Physical Findings:
Pulse 120, regular, BP 136/90, temperature 380 C, respirations 24, slightly labored. Breath sounds are decreased in bases with prolonged expiratory phase. Loose, nonproductive cough. Patient has an IV and is in a regular room.
Lab Data:
pH 7.32, PaCO2 59, HCO3 -32, PaO2 50, SaO2 84%, FiO2 0.21, WBC 11,200 Hgb 13.3, hematocrit 44
Order:
O2 via 0.28 Ventui (air entrainment) mask.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

16. Patient 2: Adolph Petroni
Lesson: Medical Gas Therapy
Patient Cases
Patient 2: Adolph Petroni
Patient:
Adolph Petroni, a seventy-two year-old male. Admitted this morning through the emergency department for shortness of breath secondary to COPD. Patient is alert and oriented, and is in a regular room.
Physical Findings:
Pulse 120, regular, BP 140/80, temperature C, respiration 24, labored. Breath sounds decreased throughout with rhonchi superimposed over a prolonged expiratory phase. Patient has a productive cough with thick yellow sputum.
Lab Data:
pH 7.44, PaCO2 58, HCO3 -38, PaO2 50, SaO2 83%, FiO2 0.21, WBC 9,800, Hgb 16.9, hematocrit 49
Order:
Oxygen via nasal cannula at 6 Lpm.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

17. Lesson: Medical Gas Therapy
Patient Cases
Patient 3: Mary Pusche
Patient:
Mary Pusche, a seventy-year-old female. Admitted last night with a diagnosis of lung cancer. Patient is alert and oriented. She is on the oncology unit and is receiving chemotherapy
Physical Findings:
Pulse 132, regular, BP 96/40, temperature C, respiration 32, shallow. Breath sounds are decreased throughout with fine crackles on inspiration. Chest expansion is decreased in both bases.
Lab Data:
pH 7.52, PaCO2 26, HCO3 -21, PaO2 45, SaO2 86%, FiO2 0.21, WBC 3,800, Hgb 8.6, hematocrit 28
Order:
Oxygen via simple mask at 3 Lpm.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

18. Patient 4: Philip Folkstone
Lesson: Medical Gas Therapy
Patient Cases
Patient 4: Philip Folkstone
Patient:
Philip Folkstone, a thirty-six year-old male. Admitted through the emergency department with pulmonary edema secondary to congestive heart failure. Patient is alert but anxious, he is on a cardiac monitor in the coronary care unit.
Physical Findings:
Pulse 140, thready, BP 106/60, temperature C, respiration 34, shallow and labored. Breath sounds are decreased throughout with coarse crackles on inspiration. Chest expansion is decreased. Patient is sitting up in bed and is diaphoretic.
Lab Data:
pH 7.50, PaCO2 28, HCO3 -22, PaO2 48, SaO2 85%, FiO2 nasal cannula at 2 Lpm. No other blood work done.
Order:
Increase oxygen to 4 Lpm.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

19. Lesson: Medical Gas Therapy
Patient Cases
Patient 5: Bronco Lane
Patient:
Bronco Lane, a fifty-nine year-old male. Admitted this morning with acute dyspnea secondary to pulmonary fibrosis. Patient is alert and oriented; he is in a regular room and has an IV.
Physical Findings:
Pulse 120, regular, BP 146/90, temperature 390 C, respiration 28, shallow, labored. Breath sounds are decreased throughout with fine crackles on inspiration. Chest expansion is decreased in both bases. The patient is not coughing.
Lab Data:
pH 7.52, PaCO2 30, HCO3 -24, PaO2 42, SaO2 80%, FiO2 0.21, Hgb 10.2, WBC 9,400.
Order:
Oxygen via nasal catheter at 2 Lpm.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

20. Patient 6: Brewster Baker
Lesson: Medical Gas Therapy
Patient Cases
Patient 6: Brewster Baker
Patient:
Brewster Baker, a forty-five year-old male. Admitted through the emergency department with a probable myocardial infarction (pending outcome of cardiac enzymes). Patient is alert and very anxious, he is in a coronary care unit on a monitor.
Physical Findings:
Pulse 146, irregular, BP 166/102, temperature C, respiration 26, slightly labored. Breath sounds normal, chest expansion is mostly normal. No coughing. Patient is sitting in semi-Fowlers position and is slightly diaphoretic.
Lab Data:
pH 7.50, PaCO2 29, HCO3 -23, PaO2 72, SaO2 96%, FiO2 0.21, other blood work pending.
Order:
Oxygen via simple mask at 5 Lpm.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

21. Lesson: Medical Gas Therapy
Patient Cases
Patient 7: Laurie Cable
Patient:
Laurie Cable, at twenty-six year-old female. Admitted to the emergency room with acute onset of shortness of breath. Patient is alert and somewhat anxious, she is seen in the emergency room.
Physical Findings:
Pulse 136, regular, BP 146/88, temperature 380 C, respiration 26, shallow and labored. Breath sounds decreased throughout with wheezing superimposed over a prolonged expiratory phase. Patient has a dry, nonproductive cough and nasal congestion.
Lab Data:
SpO2 (pulse oximeter) 92% on room air.
Order:
Oxygen via nasal cannula at 5 Lpm.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

22. Patient 8: Marion Ravenwood
Lesson: Medical Gas Therapy
Patient Cases
Patient 8: Marion Ravenwood
Patient:
Marion Ravenwood, a thirty-six year-old female. Admitted two days ago with a prolapsed uterus. Had a hysterectomy yesterday. Patient is alert and oriented, she is in a regular room on the surgical floor, she has an IV.
Physical Findings:
Pulse 110, regular, BP 152/86, temperature C, respiration 26, shallow. Breath sounds decreased especially in the bases, fine crackles in the bases. Patient has a weak, nonproductive cough.
Lab Data:
SpO2 (pulse oximeter) 93% Hgb 12.4, WBC 12,200.
Order:
Oxygen via 35% Venturi (air entrainment) mask..
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?

23. Patient 9: Julio Delgado
Lesson: Medical Gas Therapy
Patient Cases
Patient 9: Julio Delgado
Patient:
Julio Delgado, a sixty-four year-old male. Admitted last night with an acute exacerbation of chronic bronchiectasis. Patient is alert but anxious, he is in a regular room and has an IV.
Physical Findings:
Pulse 112, regular, BP 152/90, temperature C, respiration 24, shallow, slightly labored. Breath sounds decreased with rhonchi on exhalation throughout both lungs. Patient has a weak productive cough with moderate amounts of thick, yellowish sputum. Patient is sitting up in bed.
Lab Data:
pH 7.46, PaCO2 38, HCO3 -25, PaO2 54, SaO2 90%, FiO2 0.21, Hgb 17.4, WBC 13,200.
Order:
Oxygen via nasal cannula at 4 Lpm.
Would you implement this order as it is written?
What would you recommend in its place?
Would you add or delete anything from this order?