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MOD I TECH

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bourdon gauge measures?
inlet pressure
3 indications of 02 therapy
increase hr, wob and pulmonay hypertension
5 causes of arterial hypoxemia
low ambient 02, v/q mismatch,shunt, diffusion defect, hypoventilation
4 types of tissue hypoxia
anemic, stagnant or circulatory, histoxic (cynaide poisoning), hypoxemic (hyopoxic or demand)
4 toxic effects of high dose o2 therapy
alveolar wall edema
pulmonary fibrosis
hyaline membrane formation
death of type II aveloar cells
types of evalutation procedures for o2 therapy effectiveness (pt eval)
color, wob, posture
symptoms of acute hypoxemia
dyspnea, tachypnea, tachycardia (1st response of the body to hypoxemia)
symptoms of chronic hypoxemia
fatigue, polycythemia
% of o2 in heli-ox mixture
20%
heli-ox mixture % and factor
20% 80% factor 1.8 or
30% 70% factor 1.6
indications for carbon dioxide theapy
atelectasis and hiccups, cva (stoke), retinopathy
maxiium concentration of co2 tha should be used in co2/o2 mixture
10% of CO2

90% o2 to 10% co2
maximum time for co2/o2 treatment
10 min
what should be monitore during co2/o2 treatment
hr, rr, bp
adverse side effects of co2/o2 therapy
hypotension,tachycardia, tachyphnea
rational for HBO (hyperbaric oxygen chambers)
hyperoxygenation
2 indications for transtracheal oxygen therapy
lower 02 flow (higher sats),less dilution from room air
characteristics of high flow system
meets all pt inspiratory demands. maintain fixed fio2 uneffected by rr,fixed pformance
characteristics of low flow sys
o2 flow rate no greate than 6-10 lpm, perforamance varies from breath to breath,additional flow provided by inhaled room air
Ve is determined?
ve is minutie ventilation
vt x rr

tital volume x respiratory rate
4 hazards assoc with o2 therapy
o2 toxicity, hypoventilation, absorption atelectasis,dyhydration
name high flow systems??
air entrainment masks aka venturi mask,
name 5 low flow systems
nasal oxygen cannula, catheter,simple mask,partial rebreather,non rebreather
why important to keep flow of a simple mask at min of 5-6 lpm
flow must wash out the mask and prevent rebreathing of co2
how is flow is gas adj for non rebreathing mask
increase flow to make sure bag is inflated at all times
what does HAFOE mean
hig air flow oxygen enrichment
3 factors that change fio2 on the venturi mask
jet size
entrainment port size and obstruction of fio2 ports(back pressure)
entrainment ratio of air to oxygen for 24%
25:1
entrainment ratio of air to oxygen for 28%
10:1
entrainment ratio of air to oxygen for 35%
5:1
entrainment ratio of air to oxygen for 40%
3:1
entrainment ratio of air to oxygen for 50%
1.7:1
entrainment ratio of air to oxygen for 60%
1:1
factors controlled by oxygen enclosure
temp,ox concentration (fio2)and humidity
croup tent advantages
good way to administer o2 to pediatric pts
croup tent disadvantages
frequent need toopen tent for pt care make fio2 hard to keep constant
oxy hood advantages
leave pt body accessible for medical care procedures
reg agency reponsible for quality and purity of med gaSes like o2
FDA
FOOD DRUG ADMIN
REG AGENCY FOR CYLINDER CONSTRUCTION
DOT
DEPT OF TRANS
TEST ALUMINIUM CYLINDERS HOW OFTEN
5 YEARS
TEST STEEL SYLINDERS HOW OFTEN
10 YEARS
REG AGENY FOR TANK SAFETY SYS
CGA
COMPRESSED GAS ASSOC
TANK COLOR FOR OXYGEN
GREEN
TANK COLOR FOR AIR
YELLOW
TANK COLOR FOR CO2
GRAY
TANK COLOR FOR HELIUM
BROWN
TANK COLOR FOR NITROUS OXIDE
BLUE
PURPOSE FOR CHECK VALVES AND ZONE VALVES
ISOLATE SPECIFIC AREA IN CASE OF FIRE, MAINTANCE OR CONSTRUCTION
HOW MUCH GAS DOES A BULK SYS CONTAIN
GREATER THAN 20,000 CU FT
REG AGENCY FOR INSTALLATION OF LIQUID GAS SYS
ASME-AMERICAN SOCIETY OF MECHANICAL ENGINEERS
advantage of bourdon gauge
disadavantage
accurate in any position
doesn't see flow obstruction gauge remains the same
what does PISS stand for and what are the following combinations for o2 and air
pin index safety system
o2 2:5
air 1:5
reg agency for oxygen purity, dispenation?
usp
united states pharmacopeia
purity of med o2
99.0%
recommends storage of gas cylinders?
NFPA
NATIONAL FIRE PROTECTION AGENCY
E CYLIDER IS LEAKING NITROUS OXIDE WHAT DO YOU DO?
REPLACE WASHER BETWEEN REGULATOR AND TANK AND TIGHTEN THE CONNECTION
WHY CRACK CYLINDER
DEMONSTRATE PRESSURE AND HELP REMOVE DEBRIS FOR VALVE OUTLET
PRESSURE RELIEF VALVE PREVENTS
EXCESSIVE PRESSURE FOR BUILDING UP INSIDE THE CYLINDER AND TANK RUPTURE ON
OXYGEN SUPPORTS COMBUSTION AND IS NONFLAMMABLE T OR F
TRUE
COMMON METHODE OF O2 PRODUCTION FOR COMMERICAL PRODUCTION
THE JOULE-KELVIN METHODE
REASONS HELIUM IS A VALUEABLE THERAPEUTIC GAS?
LOW DENSITY,CHEMICAL INERTNESS, BEING NONFLAMMABLE
3 TYPES OF AIR COMPRESSORS?
PISTON
DIAPHRAGM
ROTARY OF CENTRIFUGAL
WHAT IS AN AIR COMPRESSOR
PRODUCE AIR TO MIX WITH O2 TO DECREASE ITS CONCENTRATION
WORKING PRESSURE OF AIR COMPRESSOR
50 PSI
JUST THE FACTS
PISTON COMPRESSOR
ELECTRICALLY DRIVEN
POWERS VENTILATORS
PROVIDES LRG AMTS OF AIR
JUST THE FACTS
DIAPHRAM
ELECTRICALY DRIVEN
DIAAPHRAM USED INSTEAD OF PISTON, PROVIDES SM AMTS OF AIR, POWERS SMALL NEBS
JUST THE FACTS
ROTARY CENRIFUGAL
ELECTRICALLY POWERED
PUSHED AIR WITH ROTATION PROPELLORS,WATER COOLS IT AND REDUCES WEAR, HAS WATER FILTER FOR CONDENSED AIR, LARGE VERSIONS POWERS HOPITALS
THIS IS ONLY A TEST! DON'T FREAK OUT SANDY! YOU WILL SCORE AN A!!!!!!
WHAT IS A CONCENTRATOR
DEVICE THAT SEPERATES 02 FROM THE NITROGEN IN ROOM AIR. INCREASE THE CONCENTRATION OF O2
2 TYPES OF CONCENTRATORS
MOLECULAR SIEVE AND MEMBRANE
HOW DOES THE MOLECULAR SIEVE CONCENTRATOR WORK?
PUMP COMPRESS AIR, DELIVERS IT TO 1 OR 2 SIEVE BEDS WITH ZEOLITE PELLETS. THE PELLET ABSORB NITROGEN AND LEAVE 02 TO PASS THRU. O2 STORED IN RESERVIOR. SWITHES BACK N FORTH TO PURGE NITOGEN FROM SIEVE BEFD
JTF:MOLECULE SIEVE CONCENTRATOR IS MOST COMMON AND DEPENDS ON AIR FLOW
JTF:MOLECULAR SIEVE CONCEN
1-2L/MIN FIO2 IS 90-95%
2-5LPM 80-90%
10LPM THE FIO2 IS 50%
MOrE FLOW=LESS FIO2
MEMBRANE CONCENTRATOR WORKS HOW
THIN PERMEABLE PLASTIC POLMER MEMRANE SEPERATES THE 02 FROM ROOM AIR. GAS DIFUSES AT DIFFERENT RATES 02 AND H20 ARE FASTER THAN NITROGEN (N2)
JTF:MEMBRANE CONCENTRATORS
1-10 LPM IS 40% FIO2
REMAINS STABLE DESPITE FLOW
SANDY YOU RULE!
WHAT KIND OF CONCENTATOR WOULD YOU FIND IN A HOSPITAL
AND WHAT % OF FIO2
A LARGE CONCENT USES MOLECULAR SIEVE PRINC PROVIDEDS 92-95% FIO2
ADV AND DISAVANTAGES OR COMPRESSORS
DIS:NEED BACK UP TANKS FOR PWR FAILURE, SM CONCENTOR CAN'T PWR HIGH PRESSURE DEVICES (50 PSI), NOISY,$$,MAINTENCE OFTEN,

ADVANTAGES: USEFUL FOR HOME PTS ON 02, COST EFFECTIVE AT LOW LITER FLOWS
1 CU FT OF LOX EXPANDS TO ? GASEOUS CU FT?
862
WITH LOX 1 LITER WEIGHTS ? LBS
2.5
HOW IS LIQ OX PRODUCED
AIR IS FILTERED, COOLED TO FREEZING,DIVIDED, COMPRESSED,THEN WARMED TO BOIL OFF OTHER GASES
LOX ADV AND DIS
ADV: SHIPPING IS LESS $ THAN GAS CYL,LESS SPACE, PROVIDES LRG AMT OF O2,SMALLER CAN BE FILLED BY LRGER
DIS:LOSS OF 02 DUE TO VENTING
LOW TEMP IS HAZARD (BURNS)
REG AGENCY OF STRUCTURAL SPECS OF LOX BULK SYSTEM
NFPA
NATIONAL FIRE PROTECTION AGENCY
REG AGENCY FOR CONSTRUCTION OF LOX BULK SYS
ASME
AMERICAN SOC MECH ENGINEERS
JTF: LOX BULK SYS
50 FT FROM COMBUSTI STRUCTURE
25 FROM FIRE RESIST STUCTURE
50 FROM PTS AND 10 FROM SIDE WALKS
JTF: LOX BULK SYS
HAS 2 ALARMS AND 24 HOUR COVERAGE
JTF: PIPING SYSTEMS
SUPPLied FROM TANK BANK OR LOX BULK OR BOTH, CYL BANK HAVE CK VAVLES,NEED BACK UP SYSTEM MUST LAST 24HRS
JTF:PIPING SYSTEM
REGULATOR REDUCED TO 50PSI
MADE OF COPPER,SEEMLESS, OR BRASS w COPPER,EACH FL HASE SHUT OFF ZONE VALVE
REG AGENCY FOR PIPE SYSTEM
NFPA
TYPES OF QUICK CONNECT STATATION OUTLETS
OHIO DIAMOND (BIG MIDDLE NIPPLE 2 LITTLE ONES)
SCHRADER (HEXI)
NCG (1 BIG NIPPLE 1 MEDIUM BELOW)
2 TYPES OF STATION OUTLETS
DISS AND QUICK CONNECT
JTF: DISS STATION OUTLET
FEMALE FITTING GOES OVER OPENING TILL CONTACTS PLUNGER TILL HITS STEM ALLOWING GAS TO FLOW
PRESSURE LESS THAN 200 PSI
JTF: QUICK CONNECT
MUST HAVE GAS LABEL
5 FT FROM FL
USES PLUNGER
3 AA CYLINDER MARKING MEANS?
STEEL
3AL CYL MARKING MEANS
ALUMINIUM
STAR ON CYL MARKING MEANS
STEEL CYL CAN GO FOR 10 YRS W/O TESTING
+ AFTER DATE CYL MARKING MEANS
PASSED
WORKING PRESSURE OR SVC P ON A CYL IS INDICATED ON SHOULDER AND CAN BE OVER FILLED BY ? %
10%
MARKING ON A CYLINDER
DOT (REG AGENCY)
3AA OR 3AL (MATERIAL MADE OF)
2015 (SVC PRESSURE)
HYROSTATIC TEST DATE
SER #
OWNERSHIP MARK AND COLOR CODE
LARGE CYL REGULATOR ATTACHMENT
(SPECIAL THREADS)
ASSS
AMER STANDARD SAFETY SYS
SMALL CYL REGULATOR ATTACHMENT
PISS
PIN INDEX SAFETY SYTEM
H CYLINDER TANK FACTS?
L OF 02 AND CU FT
TANK FACTOR
H CYL CONTAINS 6900 L OF O2 AND 244 CU FT
TANK FACTOR 3.14
E CYLINDER TANK FACTS?
L OF 02 AND CU FT
TANK FACTOR
622 L OF 02 AND 22 CU FT
TANK FACTOR .28
JTF: CYL VALVE
DIRECT ACTING:VALVE OPEN AND CLOSES DIRECTLY
INDIRECT ACTIONG:DIAPHRAGM OPENS OR CLOSES THE VALVE SEAT
JTF: REDUCING VALVE
REDUCES THE P FROM CLY TO WORKING P IN STAGES,
EACH STAGE HAS OWN P RELIEF VALVE
WHAT IS A REGULATOR
WHEN A FLOWMETER AND A REDUCING VALVE ARE JOINED TOGETHER
2 TYPES OF FLOW METERS
THORP TUBE
AND BOURDON
JTF: THORP TUBE FLOW METER
COMPENSATED IS ACCURATE EVEN IN BACK PRESSURE
DISadv: MUST BE UPRIGHT
JTF:BOURDON GAUGE FLOW METER
RESPONDS TO P BUT IS CALIBRATE TO READ FLOW.
INACURRATE WITH BACK PRESSURE
PROPORTIONER BLENDER DO WHAT?
MIX AIR AND O2
ALLOW PRECISE O2 TO BE DELIVER TO PT
NEED 50PSI OF O2 AND 50 OF AIR
STABEL 50 PSI SOURCE
HOW DOES A PROPORTIONER BLENDER WORK?
AiR AnD O2 ENTER CHAMBER ON OPPOSITE SIDES OF DIAPHRAM. DIAPHPRAM BALANCES PRESSURES W/ A REGULATOR. GAS PASSES THRU PROPORTING VALVE. IF GAS P DROPS ALAMS SOUNDS.
ADV , DISADV OF BLENDERS
ADV: CAPACITY TO DELIVER GAS AT FLOWS EXCEEDING 100 LPM

DISADV:$$ COMPARED TO 2 FLOW METERS, VARIATION IN INLET P WILLSOUND ALARM,DEBRIS KEEPS CK VALVE FROM SEATING AND DIAPHRAM MOVING PROPERLY
IF NO BLENDER USE 2 FLOWMETERS AND CALCULATE FLOW AND FIO2 HOW?
FIO2=(AIR FLOWx21)+(O2 FLOW X 100)/TOTAL FLOW
WHAT DO YOU NEED TO KNOW TO DESPENSE O2
DR ORDER
TYPE OF EQUIP
FREQUENCY(CONTIUNOUS OR PRN)
LITER FLOW OR FIO2
PT REQUIREMENT FOR LOW FLOW device
PT SHOULD HAVE
AVG Vt, RR and specific FIO2 SHOULD NOT BE Required
anatomic reservoir in adults is
1 cc per lb of ideal body weight about 150 cc
the anatomic reservoir is filled at what % of o2 between end of expiration and beginnin of inspiration
100% o2
cannula
flow lpm?
6-8 lpm
dries nasal mucosa at 6 lpm
anatomic resevior full at 6 lpm
cannula adv and disadvantages
adv:inexpensive,well tolerated, easy to be mobile
disadv:easily dislodged, drying, FIO2 varies
catheter advatages and disadv
adv:good for restless pt
disadv:easily plugged,overinstertion causes gastric insufflation
can't use w/ nasal obstuction
simple mask
lpm?
fio2?
6-10 lpm provide 35 -60%
nasal cannula: fio2 after 20% is increase by ??% for every lpm of flow
4%
remove catheter how often
every 8 hrs
simple mask adv and disadv
advantages higher fio2, use w pts after nasal surgery
disadv: more $$,can't eat or have oral care,closterphobic
partial rebreather
lpm and
fio2 ??
8-10 lpm enough to keep bag inflated!!!
35-60%
non rebreather
lpm and fio2?
12-15 lpm enough to keep bag inflated!!
60-100% on a good day 100% WITH PERFECT FIT
JTF:NON REBREATHER
ONE PORT OPEN ON SIDE
ONE WAY VALVE BETWEEN MASK AND BAG
JTF:NON REBREATHER MASK
POOR FIT CAN USE MASK AND CANNULA
? RANGE % OF LOW O2 CONCENTRATION?
21%-39% LOW
? RANGE % OF MODERATE O2 CONCENTRATION?
40-59% MODERATE
? RANGE % OF HIGH O2 CONCENTRATION?
GREATER THAN 60%
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