Hazards of Oxygen Therapy

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					Hazards of Oxygen Therapy

   First year Respiratory Therapy
   MJC 220
Oxygen Therapy

   The RCP is the primary member of the
    healthcare team responsible for oxygen
   RCP must be well-versed in its goals and

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Oxygen is a “DRUG”

   Must be considered as a drug
       TOO MUCH of a drug can cause overdosing

       TOO LITTLE isn’t enough to treat the symptoms

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Goals of Oxygen Therapy

   Correct hypoxemia
   Decrease symptoms associated with
   Decrease workload on cardiopulmonary

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Indications for Oxygen

   Documented hypoxemia
       PaO2 less than 60 torr or SaO2 less than 90% in
        adults and infants older than 28 days while
        breathing room air
   Acute care situation where hypoxemia is
   Severe trauma
   Acute myocardial infarction
   Short term therapy i.e. Post-op anesthesia
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Monitoring the Patient

   Clinical assessment including but not limited
    to cardiac, pulmonary, and neurological
   Assessment of physiologic parameters:
    measurement of oxygen tensions or
    saturation in any patient treated with oxygen

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Clinical Signs of Hypoxia

   Respiratory
       Increased respiratory rate (Tachypnea), dyspnea, cyanosis,
        acc muscle use
   Cardiac
       Increased heart rate (Tachycardia), hypertension
   Neurological
       Confusion or panic
       Cyanosis
       Diaphoresis
       Somnolence, confusion, blurred vision, loss of coordination,
        impaired judgment

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Long Term Sign

   Clubbing

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Precautions of Supplemental
   1. Oxygen toxicity
   2. Depression of ventilation
   3. Retinopathy of Prematurity
   4. Absorption atelectasis
   5. Bacterial infection with humidifiers
Oxygen Toxicity

   Patients exposed to high oxygen levels for a
    prolonged period of time have lung damage.
       First damage is capillary epithelium, leading to
        edema, thickened membranes and finally to
        pulmonary fibrosis and hypertension.

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A Vicious Cycle

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Depression of Ventilation

   COPD patients with CO2 retention have
    blunted stimuli to breathing
       Hypoxic drive theory
           They have a different stimulus to breathe then normal

   GOLDEN RULE: You should never stop
    giving oxygen to a patient in need.

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Retinopathy of Prematurity

   Is an abnormal eye condition in some
    premature infants who receive high FIO2s
       Retinal arteries hemorrhage and scaring cause
        retinal detachment and blindness.

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Absorption Atelectasis

   The alveoli in the lungs collapse and cause
    shunting in the capillary lung fields.
        Loss of nitrogen in the blood causes less total
        venous pressure. This leads to the collapse of of
        the alveolus.

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Pressure gradients that cause
absorption atelectasis

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Infection Control

   Therapist must use an aseptic technique
    when handling supplemental oxygen and
    humidity equipment
       Never drain water from the tubing back into the
        heated humidifier
       Always date the opened container
       Only use sterile liquids in reservoirs

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Oxygen: a fire hazard

   NEVER smoke while using supplemental
       Severe facial burns can and do happen

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Clinical Guidelines

   Consider Oxygen as a drug
   Use the lowest FIO2 ….
   Use it for the shortest possible time
   Keep oxygen below 50% if…
   If you have to - accept lower saturations than
    normal in some situations
   Check equipment regularly for contaminants

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That’s all folks!

   Any questions?

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Typical Question

Administration of high oxygen concentrations to
  a neonate for prolonged periods of time may
  result in which of the following:
 Atelectasis

 CO2 retention

 Retinopathy of Prematurity

 Pneumothorax

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Typically, which are the precautions of
  administering oxygen to patients in the
  hospital EXCEPT:
 Retinopathy of Prematurity

 Oxygen narcosis

 Absorption atelectasis

 Depression of ventilation

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