Author credentials
- Top scorer medical school finals University of Sheffield in 2022
- London Internal Medicine Trainee
- Passed MRCP part 1 and part 2
- PGdiploma in medical education
Features
- All you need for final year medical school exams
- Digital file editable Word document
- PD...
Pulmonary function tests ............................................................................................................................................................................................ 6
Consolidation on CXR ................................................................................................................................................................................................ 30
Always note when prescribing oxygen:
- Type of oxygen delivery system (nasal cannula, Venturi mask)
- Inspired oxygen concentration or flow rate
- Target oxygen saturation
- Monitoring
o Observe patient’s colour, RR, level of consciousness, O2 sats, ABG Pag
o Patient with non rebreath mask (NRBM) should have continuous pulse oximetry
|3
Management:
Presentation of type 2 respiratory failure:
- All acutely unwell patients = reservoir mask at 15 l/min to maintain optimal
- 67yo women
tissue oxygenation and prevent organ failure
- Drowsy
o Hypoxia is more dangerous than hypercapnia and will cause
- Cough green sputum
patients to have cardiac arrest if severe or prolonged.
- Past medical history of asthma
o Exceptions where O2 is only needed if hypoxic – only give
- Smokes 15 cigarettes a day
additional oxygen if O2 sats below target range
▪ MI, ACS On examination:
▪ Stroke - Oxygen sats 95%
▪ Obstetric emergencies - Alert
▪ Anxiety related hyperventilation - Widespread wheezing – lower airway, high
- Acutely unwell patient at risk of CO2 retention with no history of pitched
respiratory acidosis e.g. COPD, bronchiectasis, NMD, morbid obesity - No crackles
o Prior to availability of blood gases = NRBM oxygen - pH low
o If ABG shows CO2 retention = use a 28% Venturi mask at 4l/min + - Normal PaO2
aim for an oxygen saturation of 88-92% - High PaCO2 level
o If ABG shows normal pCO2 = adjust target range to 94-98% - Elevated bicarbonate levels
Management:
Oxygen saturation targets
- Type 2 respiratory failure
• Acutely ill patients = 94-98%
- Treatment:
• Patients at risk of hypercapnia (e.g. COPD patients) = 88-92%
o Cautious oxygenation
• Oxygen should be reduced in stable patients with satisfactory oxygen o Bronchodilators, steroids and antibiotics
saturation
o 1 hour of medical treatment then
repeat ABG
Oxygen delivery system
o if don’t respond, give NIV
- Simple Face Masks
o Deliver an oxygen concentration between 35-60%, with a flow rate of 5–10L/min
o Minimum flow rate should be 5 l/min (to eliminate the build-up of exhaled CO2).
o Cant measure how much O2 patient is receiving, worst way to deliver
o For any given flow rate, the inspired oxygen concentration achieved will vary, as it depends upon the rate and depth of the
patient’s breaths and the patient's minute volume.
▪ A high minute volume will lower the inspired oxygen concentration, as increased inspiratory flow rates will cause an
in-drawing of air so diluting the oxygen delivered
▪ Conversely slower breathing will increase the inspired oxygen concentration.
o In patients requiring prolonged oxygen therapy on the ward, humified oxygen should be considered – this uses a similar face
mask, but an additional humidification device helps to prevent drying of the patient’s secretions, which may significantly
worsen their respiratory problem.
- Nasal cannulae
o Capable of delivering an inspired oxygen concentration of between 24-50% depending on the flow rate of the oxygen (1-6
L/min).
o The inspired oxygen concentration achieved will vary, as it depends upon the oxygen flow rate and the depth and rate of the
patient’s breaths
o Maximum flow rate is 4 l/minute because higher rates can cause nasal mucosal drying and epistaxis
- Venturi masks
o Deliver precisely controlled percentages of high flow oxygen from 24-60%
o The valves are colour coded according to the percentage of oxygen delivered
o Useful in patients where a specific oxygen concentration is required for example in COPD patients.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller eugenechen. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.66. You're not tied to anything after your purchase.
