Molecular Sieve: higher flow = lower concentrations. Range <85 to 95%
Semipermeable Membranes only deliver 40%
Heliox Factors
80/20 = multiply observed flow by 1.8
70/30 = " 1.6
60/40 = " 1.4
Cannula Concentrations
24-44% O2
Simple Mask Concentration
35-50% O2
Partial Rebreathing Mask Concetration
40-70% O2
Non-Rebreathing Mask Concentration
60-80% O2
Minimum flow for Oxygen Hood
7 lpm
Flow in entrainment masks
At least 4-6 x the minute volume
Entrainment Device Concentration
28-100% O2
Indications for Heliox
upper airway obstruction
tracheal tumor laryngotracheobronchitis (crouo)
post extubation stridor
small ETT
status asthmaticus
Indications for Nitric Oxide
Neonates with hypoxic respiratory failure associated with pulmonary hypertension
? ARDS
Indications for Carbogen (CO2)
hypoplastic left heart syndrome
Usual starting dose for inhaled NO
20 ppm
Target oxygenation levels for hypoxemic & hypercarbic patients
PaO2 maintained between 50-60 torr &
saturation between 88-92%
A home care patient has a problem with his O2 concentrator and needs to change to the H cylinder of O2. If the patient's nasal cannula is receiving a flow of 3 lpm and the cylinder pressure is 1300 psig, how long can the patient receive O2?
D) about 22 hours
What is the most likely problem to watch for in a patient with severe COPD who is receiving supplemental O2?
A) hypoventilation
An order is received to set up a HFNC on a patient. What will be needed?
B) high pressure O2 & air sources, blender & humidifier
A therapist is making general rounds in the hospital and finds a patient whose reservoir tubing has fallen off his T-piece. This would result in which of the following:
B) decreased inspired O2
The risks of O2 Rx include all of the following except:
D) O2-induced hyperventilation
A patient is wearing a face tent because of facial surgery. The nurse moves the patient from an upright to a supine position. What effect will this have on the patient's respiratory status?
C) decreased inspired O2
To minimize the risk of hypoxemia during a treatment or procedure, which of the following should be done?
D) minimize the time the pt is breathing RA, increase the O2 to 100% before suctioning & make sure the replacement equipment is working properly
An anxious 68 YO patient with CHF will not keep the nonrebreathing mask on. What should be recommended to treat the patient's hypoxemia?
A) HFNC
A patient is wearing a partial nonrebreathing mask. The reservoir bag almost totally collapses during inspiration. Which of the following should be done?
A) increase the O2 flow
When checking a homecare patient's reservoir type nasal cannula, the therapist notices the reservoir does not fill and empty in synchrony with the patient's breathing pattern. Based on this, what should be done?
B) replace the cannula
What O2 delivery device should be recommended for a patient who has a variable respiratory rate, I:E Ratio and Vt?
D) air entrainment mask
The physician asks the therapist which O2 delivery device would be best for a patient who needs about 75% O2. What should be recommended?
A) nonrebreathing mask
A patient has a nasal cannula and needs to be transported on a stretcher. The E-sided cylinder will have to be laid flat under the stretcher. What flowmeter should be recommended?
B) Bourdon
An E cylinder of O2 needs to be prepared for transport. A regulator with which pinhole locations should be used?
A) 2 & 5
What is the duration of flow of an E cylinder with 1700 psig that is running at 5 Lpm?
B) 1.6 hours
The therapist is called to draw an ABG from a patient who is wearing a 35% air entrainment mask. Upon entering the room, the therapist notices that the patient's covers are drawn up over the entrainment ports of the mask. How would this affect the function of the mask?
B) the O2 % will be increased
A phone call from a homecare patient is received. The patient reports that the high pressure pop-off valve on the bubble humidifier to the transtracheal catheter is venting. In addition, the patient cannot flush out the catheter or push the cleaning rod through it. What should the patient be told to do?
D) switch to a nasal cannula
A 58 YO patient with advanced emphysema is admitted with an acute exacerbation of the condition. While breathing 2 lpm O2 through a transtracheal catheter, the patient has the following ABG's: pH 7.38 pCO2 57 pO2 47 Sat 80%. Based on these findings, what should be done?
C) increase the current O2 flow to the system to 3 lpm
A comatose patient is intubated and is receiving 35% O2 with an aerosol through a T-Piece. While watching the patient breathe, the therapist notices that during each inspiration, the mist disappears from the downstream end of the T-Piece. What should be recommended?
C) add aerosol tubing to the end of the T-Piece
A 65 YO female patient with pulmonary edema is very SOB and hypoxemic. She is ordered to have a nonrebreathing mask with 10 lpm of O2 going to it. However, she keeps taking off the mask because of her anxiety and claustrophobia. When she removes the mask, her pulse oximeter reading goes from 90% to 82%. What should be recommended to help manage this patient?
C) begin a HFNC at >10 lpm O2
An uncooperative 13 YO patient with status asthmaticus is being treated in the ED. The physician has ordered the patient to receive a 70/30 heliox mixture and continuous aersolized albuterol. What should be recommended as the best way to do this?
D) nonrebreathing mask with reservoir bag
A patient with COPD is going home. After a hospital exercise test is conducted, it has been determined that the patient will need 1 lpm O2 only when exercising on a stationary bike or when the patient feels SOB. Which of the following delivery systems should the therapist recommend?
A) molecular sieve O2 concentrator
The therapist is attempting to calibrate a polarographic O2 analyzer but finds that it cannot be done. Possible reasons for this include:
A) the membrane is torn on the tube, the electrolyte solution has evaporated, the battery needs to be replaced & water has condensed on the membrane
A patient has just been admitted to the ED with suspected CO poisoning. The physician wants the patient to receive the highest O2 percentage possible. What should be recommended?
C) nonrebreathing mask
A newborn infant with HLHS has just been transferred to the hospital. Mechanical ventilation is being instituted. What else can be done to help improve the neonate's heart function?
B) CO2 Rx
The therapist is doing QA on the department's flowmeters. After a backpressure compensated Thorpe flowmeter is plugged in, the flow is set to 10 lpm. The flowmeter outlet is partially and then completely obstructed. Which of the following should be expected?
B) the float will move downward and then to the bottom of the flowmeter
The therapist is called to evaluate a female patient known to have advanced emphysema. She is wearing a nasal cannula at 6 lpm. The nurse says she has become more drowsy and less responsive since the O2 was given to her an hour ago. Her ABG results on the O2 show: pH 7.32 pCO2 65 pO2 84. Which of the following should be recommended?
B) change her to a 24% air entrainment mask & repeat the gases in 20 minutes & monitor her closely for becoming more alert
The therapist is assisting with a bronchoscopy to obtain a biopsy of a suspicious laryngeal node on a patient. Afterward, the patient c/o SOB & a "tight"throat. Which of the following recommendations should be made?
D) give the patient 80/20 heliox
An adult patient who was rescued from a house fire is being received in the ED. The patient is wearing a simple O2 mask at 5 lpm. The SpO2 by pulse oximeter is 100% and his SaO2 from an ABG sample analyzed on a CO oximeter is 73%. What should be recommended at this time?
A) change the patient to a nonrebreathing mask
The therapist is working with a patient who has a tracheal tumor. The patient is wearing a nonrebreathing mask with 70/30 heliox. Pulse oximeter sat is 96%. The patient says it is getting harder to breathe and it is noticed that the reservoir bag has collapsed. The most appropriate action is to:
C) increase the flow of the gas
An 8 YO patient with asthma is going to be given 70/30 heliox through a nonrebreathing mask and reservoir bag. The physician ahs ordered the child to receive 7 lpm of the gas. Because it will be delivered through an O2 flowmeter, what flow should be set?
C) 4.4 lpm
A 36 week gestational age neonate is hypoxemic despite mechanical ventilation and has clinical evidence of persistent pulmonary hypertension of the newborn. What can be done to correct the hypoxemia?
C) begin NO therapy
A therapist is assigned to the ED of a mjor emdical center when a 24 YO patient with status asthmaticus is transferred by ambulance from a small rural hospital. The patient has been given continuous BD therapy and corticosteroids and aminophylline. The patient is becoming exhausted but refuses to allow intubation and mechanical ventilation. What should be recommended?
B) begin heliox rx
A neonatal patient has primary pulmonary hypertension and is receiving mechanical ventilation. After the neonate receives 20 ppm of NO therapy, PVR returns to the normal range. What should be recommended at this time?
D) decrease the NO to 10 ppm
A socially active female patient with COPD requires 2 lpm of continuous O2. She wishes to go with her Better Breathers CLub ona bus trip to shop in Chicago. What should be recommended for her in this situation?
