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O2 Therapy & Air way management techniques Abdualrahman ALshehri Lecturer King Saud University Riyadh Community College RN, MSN
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Respiratory Anatomy Nose and mouth (warms, moistens, and filters air). Pharynx –Oropharynx –Nasopharynx Epiglottis Trachea (windpipe)
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Respiratory Anatomy Cricoid cartilage (adams apple). Larynx (voice box). Bronchi Lungs –Visceral pleura (surface of lungs) –Parietal pleura (internal chest wall) –Interpleural space (potential space)
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Respiratory Anatomy Diaphragm Inhalation (active process) –Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity. –Diaphragm moves slightly downward, ribs move upward and outward. Air flows into the lungs creating a negative pressure in the chest cavity.
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Respiratory Anatomy Exhalation (passive process) Diaphragm and intercostal muscles relax decreasing the size of the thoracic cavity. –Diaphragm moves upward, ribs move downward and inward. Air flows out of the lungs creating a positive pressure inside the chest cavity.
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Respiratory Physiology Oxygenation - blood and the cells become saturated with oxygen Hypoxia - inadequate oxygen being delivered to the cells Signs of Hypoxia –Increased or decreased heart rate –Altered mental status (early sign) –Agitation –Initial elevation of B.P. followed by a decrease –Cyanosis (often a late sign)
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Alveolar/Capillary Exchange Oxygen-rich air enters the alveoli during each inspiration. Oxygen-poor blood in the capillaries passes into the alveoli. Oxygen enters the capillaries as carbon dioxide enters the alveoli.
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Capillary/Cellular Exchange Cells give up carbon dioxide to the capillaries. Capillaries give up oxygen to the cells.
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Functions of the Respiratory System: Overview Exchange O 2 –Air to blood –Blood to cells Exchange CO 2 –Cells to blood –Blood to air Regulate blood pH Vocalizations Protect alveoli
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Factors Affecting Ventilation Airway Resistance Diameter Mucous blockage Bronchoconstriction Bronchodilation Alveolar compliance 1.Surfactants 2. Surface tension Alveolar elasticity
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Page 11 Gas Exchange in the Alveoli Thin cells: exchange Surfactant cells Elastic fibers –Recoil –Push air out Thin basement membrane Capillaries cover 90% of surface
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Page 12 Gas Exchange in the Alveoli
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Page 13 Oxygen movement
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Page 14 Oxygen movement
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Page 15 Oxygen movement
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Page 16 Oxygen Therapy For over 200 years oxygen therapy has often been used and sometimes misused (Hough 2001)
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Page 17 Oxygen Therapy Should be prescribed Acute and chronic respiratory conditions Personnel should be trained in its use Protocols
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Page 18 Oxygen Therapy - Indications Hypoxaemia (PaO2<8KPA, O2sats<90%) Acute or chronic respiratory condition Pre and post suction Routinely post operatively Optimise oxygen delivery
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Page 19 Oxygen therapy - limitations Giving oxygen does not guarantee it’s arrival at the mitochondria Oxygen does not improve ventilation directly (Hough 2001)
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Page 20 Oxygen therapy – complications/cautions Respiratory depression if hypoxic drive Pulmonary oxygen toxicity Tracheobronchitis Absorption atelectasis Fire Variable delivery
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Page 21 Oxygen Therapy - Monitoring Oxygen saturations continuous/intermittent Arterial blood gases Observation
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Page 22 Oxygen therapy – delivery devices Low Flow masks (variable performance) High flow masks (fixed flow)/venturi Nasal cannulae Mask and reservoir bag Tracheal mask/t-piece Tracheal speaking valves Mechanical ventilator
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Page 23 Oxygen Therapy - low flow masks Commonly used Variable performance
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Page 24 Oxygen therapy – high flow masks Guaranteed percentage of oxygen Venturi system More expensive Up to 60%
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Page 25 Nasal cannulae 1l/min 24% oxygen 2l/min28% oxygen 3l/min32% oxygen 4l/min36% oxygen
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Page 26 Oxygen therapy – bag and mask High concentrations of oxygen Mask and reservoir bag 55-90%
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Page 27 Oxygen Therapy tracheostomy T-piece Mask Swedish nose Speaking valve
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Page 28 Long term oxygen therapy Chronic hypoxaemia Increases survival Aim to raise PaO2 to >8Kpa Worn as much as possible >15hours Cylinders/concentrators/liquid
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Page 29 Humidification Mucocillary escalator Adequate hydration is vital Bacterial contamination!!!
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Page 30 Humidification - indications URT bypassed Thick retained secretions High flow oxygen/non-invasive mechanical aids
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Page 31 Humidification - Cautions Hyper-reactive airways - bronchospasm Infection Burns
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Page 32 Humidification - Types Nebulisers Large/Small/Ultrasonic Steam
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Page 33 Humidification - Humidifiers Hot - Increases moisture content - Increases risk of infection Cold - Poor moisture content
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Page 34 Non-invasive ventilation BiPAP CPAP IPPB
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