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Respiratory Therapy 101

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Respiratory Therapy 101 Understanding Oxygen Therapy in less than an Hour – PowerPoint PPT presentation

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Title: Respiratory Therapy 101


1
Respiratory Therapy 101
  • Understanding Oxygen Therapy in less than an Hour

2
Oxygen Cannula
  • Can safely be used at flow rates of 1-6 LPM
  • Flow should not be turned above 6 LPM
  • Produces 24 to 44 oxygen to patient

3
Oxygen Cannula
  • Liter Flow
  • Oxygen
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 24
  • 28
  • 32
  • 36
  • 40
  • 44

4
Oxygen Humidifiers
  • Used with oxygen cannulas to prevent nasal drying
  • May not be used at flow rates less than 3LPM
    (need to bubble to be effective)
  • Check water level and change as needed

5
Oxygen Humidifiers
6
Reservoir Cannulas
  • Stores oxygen in a reservoir on exhalation so the
    patient has more oxygen available on inhalation
  • Capable of providing higher oxygen percentage at
    a lower flow rate

7
Two styles of Reservoir Cannulas
8
Simple Oxygen Mask
  • Flow rate should be from 5 to 10 LPM
  • Flow rate should NOT be Less than 5 LPM
  • Oxygen delivery is approximately 35 to 50
  • Short term use only
  • No Humidity

9
Simple Mask
10
100 Non-Rebreather Mask
  • Set oxygen flow to a setting that does not allow
    the reservoir bag to collapse with the patients
    inspiration (10 15 LPM)
  • If tight fitting to patients face, 100 oxygen
    can be given
  • Usual oxygen percentage is 60 to 80
  • USED BY EMS

11
Non-rebreather Masks
12
High Flow Systems Air Entrainment Mask (Venturi)
  • Percent of oxygen delivered depends on the LPM
    flow, the size of the jet, and the size of the
    entrainment port
  • Delivers a precise oxygen percentage
  • Entrainment ports must be kept open
  • Most accurate way to deliver O2
  • Ideal for CO2 retainers

13
High Flow System Air Entrainment Mask
14
High Flow System Air Entrainment Mask
  • The flow of 100 oxygen through the mask and
    draws in a controlled amount of room air (21 per
    cent oxygen).
  • Commonly available masks deliver 24, 28, 31, 35,
    or 40 per cent oxygen. At concentrations above 24
    per cent, humidification may be required. (Color
    coded depending on manufacturer)

15
High Flow System Air Entrainment Mask
16
Oxygen Blender
  • Controls precisely the percent of oxygen the
    patient is receiving
  • High flow meter is required for use

17
Oxygen Blender
18
How do I know if my Patient is Oxygen Deprived???
?
19
Clinical Respiratory Signs of Hypoxia
  • MILD to MODERATE
  • SEVERE
  • Tachypnea
  • Dyspnea
  • Paleness
  • Tachypnea
  • Dyspnea
  • Cyanosis

20
Cardiovascular Signs of Hypoxia
  • MILD to MODERATE
  • SEVERE
  • Tachycardia
  • Mild Hypertension
  • Peripheral Vasoconstriction
  • Tachycardia, eventual bradycardia, arrhythmia
  • Hypertension and eventual hypotension

21
Neurologic Signs of Hypoxia
  • MILD to MODERATE
  • SEVERE
  • Restlessness
  • Disorientation
  • Headaches
  • Lassitude
  • Somnolence
  • Confusion
  • Distressed appearance
  • Blurred Vision
  • Loss of Coordination
  • Impaired judgment
  • Slow reaction time
  • Manic-Depressive activity
  • Coma

22
Monitoring Oxygen with an Oximeter
  • Monitors the adequacy of arterial oxyhemoglobin
    saturation
  • Usually maintained at values above 90
  • Only provides valuable data when patient has
    normal hemoglobin
  • Light and nail polish can alter saturation
    readings

23
ETCO2 Monitoring
Used with post surgical patients on PCA pumps,
Epidurals and Mechanically Vented patients
ETCO2 measures ventilation, not saturation (end
product of breathing is CO2) (See pamphlet)
24
Monitoring Oxygen with ABGs
  • Pa02 reflects oxygenation levels
  • Normal Pa02 is 80-100mmHg (lt60 mmHg-needs
    intervention).
  • Pa02 Values below 55 mmHg are Critical
  • Normal Pa02 values decrease
  • with age
  • Hypoxemia low PaO2 lt80

25
ABG Review
  • pH 7.35 to 7.45
  • lt7.35 Acidic and gt 7.45 Alkalotic
  • PaC02 35 to 45
  • HC03 22-26 (28)
  • Cost of ABG (800-1500/draw)
  • Invasive Procedure
  • ROME Respiratory Opposite direction
  • Metalbolic Equal (same) direction

26
What is CPAP???
  • Continuous Positive Airway Pressure
  • Application of positive pressure to a patients
    airway throughout the respiratory cycle
  • Increases the patients FRC (functional residual
    capacity)
  • Improves oxygenation
  • Also, used to prevent airway collapse in
    treatment of obstructive sleep apnea

27
What is BiPAP?? Non-Invasive Positive Pressure
Ventilation (NIPPV)
  • Provides two levels of pressure to the patient
  • One pressure on the inspiration (IPAP)
  • One pressure on the expiration (EPAP)
  • May be used in patients with acute, short-term
    respiratory problems to avoid intubation and
    invasive mechanical ventilation
  • Improves the ability to remove CO2 and provide O2

28
Facial and Nasal Masks
29
Non-Invasive Positive Pressure Ventilator Support
30
FiO2
  • Fractional concentrated of inspired oxygen
    delivered
  • Percentage of Oxygen delivered or participating
    in gas exchange
  • in the alveoli (0.21 to 1.0)
  • Expressed in . (0.35 is 35).

31
Oh my GOD!! My patient is on a ventilator!
32
Drager Ventilator
33
(No Transcript)
34
BASIC VENTIALTOR MODES
  • VOLUME CONTROLLED
  • tidal volume (volume of air inhaled)
  • PRESSURE CONTROLLED
  • PIP (positive inspiratory pressure)

35
Basic Ventilator Parameters Breath Rate (f)
  • Number of times per minute that inspiration is
    initiated (controlled by ventilator, patient or
    combination of both).
  • Two things to know
  • Ventilator Setting (rate) (f)
  • Patient Rate (BPM)
  • Rate (f) setting and Patient breathing rate are
    not the same thing

36
Basic Ventilator Parameters Tidal Volume (vT)
  • Amount of gas delivered during an inspiration in
    ml or liters
  • Average adult tidal volume is
  • 500-550 ml or .500 -.550 L
  • Setting in volume control modes
  • Not a setting but volume
  • readings are measured in
  • pressure control modes

37
Basic Ventilator Parameters Peak Inspiratory
Pressure (PIP)
  • Maximum pressure reached in the ventilator system
    during inspiration
  • Set parameter in pressure setting modes (Pressure
    Controlled Ventilation - PCV)

38
PEEP
  • Positive End Expiratory Pressure
  • Application of a constant, positive pressure such
    that at the end of exhalation, airway pressure
    does not return to zero
  • Improves oxygenation

39
Basic Ventilator Parameters Breath Types
  • Mandatory ventilator controls all parts of
    breathing
  • Spontaneous patient controls all parts of
    breathing
  • Assisted Breaths patient controls breathing
    rate, breaths are assisted with a set Vt (tidal
    volume)

40
Basic Ventilator Parameters Common Modes of
Ventilation
  • CMV
  • A/C
  • VC
  • SIMV
  • SIMV PS
  • PSV

41
CMV Mode (volume) most common type used is Assist
Control (A/C)
  • Continuous mandatory ventilation
  • Continuous mechanical ventilation
  • Every breath is mandatory or assisted
  • Set minimum breath rate
  • CMV patient does not determine breathing rate.
  • A/C patient determines breathing rate.
  • Patient does not work
  • Delivery of a mandatory or assisted breath at a
    set rate

42
SIMV Mode (volume , sometimes pressure)
  • A minimum number of breaths delivered with a
    tidal volume (assisted) is set on the ventilator.
  • Respiratory rate and tidal volumes are set
  • Patient may breath spontaneously between the
    number of set assisted breaths
  • Weaning mode (usually)
  • Set PEEP and sometimes
  • pressure support is set

43
Pressure Controlled Ventilation (pressure)
  • Delivers breaths at a preset pressure limit
    (equal to PIP).
  • When ventilator delivers a breath, it continues
    delivering the volume until the pre-set pressure
    limit is reached, then it stops delivering the
    breath.
  • Settings Pressure limit (PIP) and IE ratio but
    not the tidal volume (tidal volume will vary).
  • IMPORTANT NOTE unnatural feeling of breathing
    NEEDS SEDATION!
  • With control modes increases mean airway and
    intrathoracic pressures rise, may decrease
    Cardiac Output, very important to monitor
    hemodynamics (BP, HR, CVP)

44
Pressure Support Ventilation PSV (pressure)
  • Augments or assists spontaneous breathing efforts
    by delivering a high flow air to a selected
    pressure level early in inspiration and maintains
    that level throughout the inspiratory phase.
  • When PSV is used as a stand-alone mode the
    pressure support level is adjusted to achieve the
    targeted tidal volume and respiratory rate. (Vt
    and f are not set - patient determines own
    respiratory rate and tidal volume
  • Reduces the work of breathing for the patient by
    reducing the resistance of breathing through an
    ET tube and circuit tubing.
  • A lot of time this mode is combined with SIMV and
    CPAP mode.
  • At High pressures PSV can provide nearly total
    ventilator support.
  • Because level of pressure can be gradually
    decreased, endurance conditioning is enhanced in
    PSV modes. Great for weaning!

45
CPAP Mode (pressure)
  • Not the same as CPAP by mask at home or is it????
  • Supplies pressure throughout the respiratory
    cycle, helping to improve oxygenation in
    spontaneously breathing patients.
  • No setting on ventilator for rate or tidal
    volumes (patient determines own rate and their
    own tidal volume).
  • FiO2, PEEP, PS (pressure support) can be set.
  • Should not over sedate people on this mode.
  • Monitor breathing rate, apnea alarms!!
  • May be used on intubated or non-intubated
    patients via mask.

46
Alarms
  • High inspiratory pressure or pressure limit
  • Low inspiratory pressure
  • Low exhaled tidal volume
  • High or low minute volume
  • Apnea
  • High rate or frequency
  • Low PEEP/CPAP

47
High Inspiratory Pressure Alarm
  • Coughing
  • Secretions in the airway
  • Biting on the ET tube
  • Bronchospasm
  • Patient Ventilator asynchrony
  • Kinking of ventilator circuit

48
Low Inspiratory Pressure
  • Low exhaled volume
  • Patient Disconnected
  • Circuit Leaks
  • Airway leaks

49
When in Doubt Always Ask!! Your Respiratory
Therapist Is Your Friend!!!!!!!
  • And to keep your patients breathing forever!
  • They are here to help!
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