CPP007 Oxygen therapy

Question 1

In the presence of normal oxygen saturations (SPO2)

Answer 1

Patients should NOT be routinely administered O2 in the presence of normal SPO2 except in the case of critical illnesses:

a) Cardiac arrest,
b) major trauma/head injury,
c) Undifferentiated (or septic ) shock,
d) Anaphylaxis,
e) Seizures.

Question 2

Oxygen therapy

Oxygen targets:
a) Most patients,
b) Chronically hypoxaemic patients.

Question 3

Oxygen therapy

Who are going to be your chronically hypoxaemic patients?

Question 4

Oxygen therapy

Fraction of Inspired Oxygen (FiO2).

Answer 4

Fraction of inspired oxygen (FiO2) is the percentage or concentration of oxygen in the air mixture that a person inhales.

Under normal atmospheric conditions, the FiO2 is approximately 21%, as this is the oxygen concentration in room air

Question 5

Oxygen therapy

The suggested flow rate and (FiO2) delivery systems are as follows:

Answer 5

Nasal cannulae. FiO2 > 21-35%.
Flow rate 1-6L/min

Nebuliser mask (NEB). FiO2 40-50%.
Flow rate 8L/min

Hudson mask. FiO2 40-60%.
Flow rate 6-8L/min

Non-rebreather mask (NRB). FiO2 >60%.
Flow rate 10-15L/min

Bag valve mask (BVM). FiO2 100% (good seal)
Flow rate 15L/min or enough to inflate reservoir bag

Question 6

Oxygen therapy

Oxygen administration guidance

First question to ask? And…
What is the next step?

Answer 6

Is our patient hypoxic?
ie. SPO2 <92% RA.

If our patient is hypoxic, escalate care
as per CPP006 Clinical escalation.

Question 7

Oxygen therapy

So you’ve determined that the patient is hypoxic, and you have escalated care.

Now what?

Answer 7

Manage underlying condition per appropriate CPP.

• Asthma CPP017,
• Acute cardiogenic pulmonary oedema CPP014,
• Anaphylaxis CPP020.

Question 8

Oxygen therapy

Management
NOT chronically hypoxaemic patient

Answer 8

What underlying condition are they presenting with?
eg. Asthma? Anaphylaxis? Mng as per appropriate CPP.

• Select O2 delivery approp to pt needs,
  What degree of hypoxia?
• Titrate O2 delivery to achieve SPO2 of 94-98%.

Question 9

Oxygen therapy

Management
Patient is chronically hypoxaemic

Answer 9

What underlying condition are they presenting with?
eg. Asthma? Anaphylaxis? Mng as per appropriate CPP.

• Generally nasal cannula is preferred.
  Work through delivery systems as req.
• Titrate O2 delivery to achieve SPO2 of 88-92%.

Question 10

Oxygen therapy

What is IPPV?

Answer 10

Intermittent Positive Pressure Ventilation
Sometimes called IPPB,
Intermittent Positive Pressure Breathing.

A patient-triggered ventilation system that can assist with lung expansion.

IPPB was designed to help patients take deeper breaths, stimulate a cough, and treat or prevent atelectasis
(Atelectasis is the collapse of a lung or part of a lung due to loss of air in the alveoli).

Question 11

Oxygen therapy

Management of
Inadequate ventilation
(RR<8 and hypoxia).

Answer 11

What is the underlying condition?
eg. Anaphylaxis? Cardiac arrest?

Insert airway adjunct as req:
- OPA,
- NPA,
- SGA.

Apply IPPV.

Question 12

Oxygen therapy

The atmospheric air that we inhale on a day-to-day basis

Answer 12

This is made up of 21% oxygen, 78% nitrogen and 1% trace elements such as argon, carbon dioxide, neon, helium and methane.