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what are the equipments available for oxygen therapy and mechanical ventilation
- 50psi regulator with flow gauge
- pressure compensated flowmeter(hangs on wall)
- oral suction
- e-size oxygen cylinder
- oxygen connecting tubing (1/4 inch)
- suction catheter
- nasal catheters (varying size)
- e-collar
- endotracheal tube
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ways to determining the need for o2
- observe the respiratory patterns and effort
- chest wall auscultation
- chest wall palpation
- oral exam
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"At the _____ sign of _____, administer O2
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observation-signs indicating some degree of hypoxia
- nasal flaring
- irregular chest wall movement
- "panting"
- cyanosis
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auscultation- what are you listening for?
- bubbling
- gurgling
- wheezing
- unusual sounds
- lack of sound
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harsh sounds means
increased sound on expiration (usually quiet when exhaling)
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crackle sounds mean
fluids in the airways like blood or pus
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wheezing sounds mean
airway obstruction
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decrease sounds mean
fluids or air in the pleural space or air in tissues
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chest wall palpation-what are you feeling for?
- swelling
- contusions
- punctures
- any distortion
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monitoring devices-pulse oximetry
- commonly used
- will determine how well the hemoglobin is saturated by a precentage
- does not determine how well the animal is ventilating
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monitoring devices-fractional inspired O2 (FiO2)
- amount of O2 in enviroment/system
- evalutes whether the animal is able to oxygenate normally
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monitoring devices-arterial blood gas
- PaCO2-indicates ventilation
- PaO2-indicates ventilation/perfusion
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5x FiO2 Rule
- estimates where PaO2 should be if heathy
- room air=100% PaO2
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PaO2 : FiO2 ratio (%/% as decimal)
- mild disease=300-500
- moderate disease=200-300
- severe disease= less than 200
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oxygen
- can have a drying effect on MM
- generally has a calming effect
- high doses can cause euphoria
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sedation
- used when stressed by O2 supplementation
- any type can compound resporatory distress
- monitor closely for apnea (resp drive to stop)
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what are some things used to deliver oxygen?
- blow by/flow by
- bag
- nasal catheter
- nasal prongs
- nasal tracheal catheters
- transtracheal oxygen
- oxygen mask
- oxygen collar
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blow by or flow by
- hold end of O2 line 6 inches from the nares/mouth- do not aim directly at the nose
- 6 L/min flow rate- FiO2 less then 35% due to mixing
- easy first type of support
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bag method
- used for small to medium animals in carrier
- enclose the carrier in a clear plastic bag and the O2 line administers high flow of O2
- temporary support until others started
- initial stress free suppot, allows setup for other types of support or sedation, use 30 min or less because it lacks ventilation
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nasal O2 catheters
- red rubber feeding tube (RRFT) approriate-silicone best because less irritating to nasal mucosa to which dried mucus does not adhere
- 3-8 french catheter (fr)
- topical anesthetic-crunch nose up, ventromedial angle
- super glue or sutures
- humidification
- FiO2 about 40-50%
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nasal prongs
- depends on space between the nostils
- flow rate of 3-6 L/min- FiO2 40-50%
- still can cause irritation so best to use topical anesthetic
- humidification
- check frequently because slips out easily
- suture or staple in place
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nasal tracheal catheters
- placed like nasal catheters- extend to epiglottis and into trachea
- used in larygeal disease or collapse trachea (CT)
- can supply more then 50% FiO2
- not tolerated well and higher complications -coughing due to contact with epiglottis, topical anesthesia of area, mild sedation often needed, inceased risk of aspiration
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transtracheal oxygen
- surgically placed catheter- same as nasal or tracheal silicone best
- prep and local block at 4th-5th ring
- puncture to facilitate catheter intoduction
- tip of catheter to the carina
- approximate flow rate of 3 L/min- based on ventilation, PaO2-deep and rapid +/- increase rate
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oxygen collar
- less restrictive and irritating than others
- low flow rate?yes
- homemade with e-collar and saran wrap
- O2 heavier than air-lower 2/3 O2 rich
- humidity and heat-keep eyes moist, watch for xs humidity and heat
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oxygen cage and incubators
- not the best for critical control
- flow rate 15 L/min might give FiO2 40%-leaks significant, dead space
- open freguently so long "recharge" period
- bacterial growth in humidifiers-pseudomonus
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hyperbaric oxygen
- 100% oxygen at more than normal pressure
- O2 in blood and tissue up to 20x normal
- treatment for- carbon monoxide, nonhealing wounds, bone/joint infections from septicema, crush injury
- few exist in vet machine
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