oxygen therapy - dr. satish deopujari

2

Oxygen therapy Dr.Deopujari

O2

36 A.T.P.

2 A.T.P.

L.ACID

BODY OXYGEN STORES ALL

SMALL AND IF DEPLETED

THEY ARE INSUFFICIENT TO

SUSTAIN LIFE FOR MORE

THAN FEW

MINUTES

RESP.

C.V.S.

C.N.S.

SEPS.

M.

O.

F.

Oxygen was first used as a

remedy for illness in 1783 in

France by Chaussier. In

December of 1907, it was

used in surgery on a woman

who had tremendous internal

damage. It was administered

directly into the abdomen

and marked recovery was

noted.

25

50%

60

90%

0

10

20

30

40

50

60

70

80

90

100

SO2

0 10 20 30 40 50 60 70 80 90 100 110

pO2(mm Hg)

O.D.CURVE

O.D.CURVE

0

20

40

60

80

100

120

0 10 20 30 40 50 60 70 80 90 100 110

PO2

SO

2

Rt..

HB% 12

SAT 100%

HB% 12

SAT 50%

HB 6 GR

SAT 100%

HB 13 GR

SAT 90%

PaO2 SATURATION

2

TISSUES

CaO2 = (SAT x Hb x 1 . 3 4 ) + .0 0 3(PaO2)

PaO2 / FiO2 Ratio or "P/F” Ratio

Another much friendlier method

( because it doesn't use the alveolar gas

equation) used to predict shunt.

Just like the name says, PaO2 is divided by

FiO2

Normal is 286; lower indicates a shunt.

CLINICAL D. OF HYPOXIA

DISPRAP. BRADY / TACHY .

ALTERED SENSORIUM / SEI.

SHOCK. G.I.BLEED

MULTISYSTEM INV.

ANTICIPATE HYPOXIA

ROVING EYES

UNRESPONSIVE PUPIL

• PERFUSION DEPNDENT

SAT. NOT CONTENT

SHAPE OF O.D.CURVE

HYPEROXIA NOT DIAG.

POSITION OF CURVE

ABNORMAL HEMOGLOBIN

VENTILATORY STATUS ?

P

U

L

S

E

0

X.

SIMPLE OX. MASK

FIO2 VARIABLE

30 TO 60 %

FEEDING PROBLEM

REBREATHING……

NASAL CANNULA

MAX FLOW……2LIT/MIN FIO2 DIF. TO CONTROL HUMIDI. NOT NEC. MOUTH / NOSE BREAT.?

NASOPHARYN. CATH.

OROPHARYNX….ANAT. RES. OCCL. OF DIST. OPENING. GASTRIC DISTENSION FIO2 DIFFICULT TO CONT. SECRETIONS CATHER MORE THAN 8 FR.

2

AIR ENTRAINMENT V.

PRE. O2 CONC. <50 %

T. FLOW WITH FIO2

NOISE LEVEL ++++

HUMIDIFICATION ?

24% 4lit 105

28 6 68

31 8 63

35 10 56

40 12 50

50 12 33

FI O2 O2/L/MIN FLOW

YOU

ALMOST

NEVER

NEED

100 %

OXYGEN

HEAD BOX

LOW

PRESSURE

OUTLET

OXYGEN CONCENTRATOR

PATIENT

O2

PARTIAL REBREATH. M.

RES. BAG

O2

NON REBREATH. M.

RESE. B.

PATIENT

100%

OXYGEN

Non-Rebreather masks achieve close to

100% oxygen by minimizing room air

entrainment and by attaching a

reservoir bag filled with 100% oxygen.

The reservoir bag has a flap valve to

block exhaled gas from entering.

Exhaled gas is directed out the side

ports with flap valves to block air

entrainment on inspiration.

TRANS

TRACHEAL

CATHETER

BLENDED

HUMIDIFIED

OXYGEN/AIR

SOURCE

The unconscious patient

who "looks at heaven"

will soon be going there.

(--The supine

unconscious patient is

predisposed to airway

obstruction.)

OXYGEN TOXICITY

R . O . P. PULMONARY

CARDIAC

NEUROTOXICITY

REPERFUSION INJURY

FREE RADICLES

MISCLENOUS

Prescription of oxygen

ABG PaO2

<60 >60

>7.2 <7.2

pH

PaCO2

FIO2 >40 % ADD CPAP 6

INC. 5% NO CH.% RED. 5%

>70 50 TO 70 < 50

PaO2 >70 50 TO 70 < 50

INC. 5% NO CH.% RED. 5%

FIO2 >50% CPAP 8 C.M.

FIO2 < 30 %

RED. CPAP 1 CM CONSIDER M.V.

PaCO2

RESPIRATION

GOOD DEEP R . POOR

SAT 93 % SAT 94%

SAT 92

SAT 90 %

FIO2 50%

CPAP 5

CPAP 8

M.V.

EATH IS USUALLY

DUE TO THE PHYSI.

DIST. CAUSED BY

THE DIS. RATHER

THAN THE DIS.

PER SE………...

D E

A

T

H

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