Oxygen Treatment - Equipment And Scenarios

Yeah, kind of a stupid question, but also a good reinforcement to show the major "con" of this device.

Oh, and the bourdon is gravity-independent, so even if "flipping a tank" would ever do anything (it won't), it wouldn't need to be done anyway. This may be good to know if you ever have to have a tank upside down.

Although all of these answers may seem like fine choices at certain times. The BEST route to take would be to try to get the patient to use a cannula at 2-3L, as this will put the flow somewhere in the ballpark of 28+% and he will still be able to talk and eat freely.

No, it's not a trick question. The simple mask needs to be operated at a minimum of 5L/min in order to facilitate the removal of carbon dioxide. Switching to either of the two other options would be even worse, as you need about 10L to begin to do anything with them.

I know it is worded funny, taking Jen's tests has taught me to be aware of these kind of things that lead you in the wrong direction. The Non-Rebreather actually DOES have 1-way valves which let exhaled air exit but close off the ports during the inhalation, providing for the higher fiO2 range of the device.

The non-rebreathing mask is the best bet here due to the patient's pulmonary edema. Although the non-rebreathing mask is a variable O2 device, the bottom of its range just happens to fall at 60 (memorize those ranges!). A nebulizer might be a fine choice other than it would add additional moisture to the airways. Air-entrainment mask only goes up to 50%, and the cannula only goes up to 40% and is also variable.

This is an almost complete rip-off of Rose's example, but I think it is a good one to go over. I want to think - max fiO2 = 100%, the only problem is that 100% is not always practical (or possible) in situations like this where the patient is being transported. Blender systems and non-rebreathing circuits require extra equipment and multiple connections and a bunch of stuff you don't want to mess with on the go. The nebulizer mask might work, but if the patient is not able to hold the the nebulizer bottle it might make for a sloppy, wet trip. At least that's the way I overheard Rose explaining it.

A Bourdon gauge is found only with adjustable reducing valves since the adjustable pressure is what causes the flow changes in this device.

Flow restrictor valve does not exist, but a flow restrictor is actually a type of flowmeter itself. Both other option are other types of reducing valves.

Based on the "Rule of Thumb" shared by Rose and featured in all of it's glory on page 877 (Egan's). In class we were given the 20+ 4 for each additional liter, and in the book it has 21, so hopefully somewhere in there is good enough.

Although it does provide a high fiO2 (60-80%), the fiO2 delivered will depend on how fast and deep the patient is breathing (variable).

The tubing and nozzle are the giveaways on this one.

Although Egan's says that 10LPM is what is needed to keep the bag from collapsing, I'm guessing that could be low in many cases.

Although nothing specific was ordered and any of these might accomplish the goal, the way I understood it was to go for the biggest bang for your buck, which in this case happens to be the nonrebreather which provides 60-80% variable fiO2.

Both the 1st and 3rd options are correct. Because of the distal placement of the needle valve on a pressure compensated thorpe tube, backpressure is prevented from messing with the reading in the tube and will not affect the reading.

Oh, and all thorpe tubes are made to be connected to 50psi wall outlets.

This question uses a number of different things to spin your head around, but if you go through the steps of calculating the inspiratory flow rate (.600/1)*60 = 36L/min.

Now that we know the patient's flow rate, we can calculate what we are giving him with the current setup. At 40% the air:oxygen ration turns out to be 3:1

(100-40)/(40-20) = 60/20 = 3/1

Knowing that we can figure out that at 10L/min the patient is receiving 10L/min O2 + 30L/min entrained room air = 40L/min at fiO2 of 40%.

Since the patient is receiving 40L/min and only requires 36L/min everything addressed in this scenario should be fine.

Interestingly enough, whoever didn't follow the guidelines on the nozzle knew that at 8L/min the patient would only be receiving 32L/min and would not get the full inspiratory requirement.

Strangely enough, I thought I was pulling these numbers somewhat out of the air but then noticed earlier that Sibberson's uses the same sort of example (p.52).

Simple mask has FiO2 range of just 35-50%.

Maybe kind of tricky because of the number I selected, but since you need a fixed device (dr.'s orders) the venti mask would be the best choice out of those given. In some situations you would maybe choose a nebulizer mask over the venti mask, but since there is usually a 31% nozzle and nothing specifying mentioned about needing added heat/humidity you would probably go with the venti.

If the mask was 100% non-leaking, had perfect valves, and was provided with enough flow to prevent bag collapse it would theoretically provide 100% fiO2, modern disposable (cheap) masks do not typically provide more than 70%. (Egan's p.860 sourcing Branson RD) On Egan's table 38-3 it specifies 60%-80% as the range.

The venti-mask (air-entrainment mask) can only go up to 50% (and according to the book it is shaky even above 40% but I digress) and so another solution is needed.

Partial and nonrebreathing masks are variable and therefore won't fulfill the Dr.'s orders of "65%". Transferring them to another floor might be a good idea, but a nebulizer mask will allow a fairly easy method of delivering fixed oxygen all the way up to 100% along with the ability to provide temperature and humidity control of the inspired gas.

Nasal catheter has an FiO2 range of 22-45% and is variable.

A fixed device provides for all patients demands, whereas a variable device depends on how hard and fast the patient is breathing (as well as things like mask fit, mouth breathing with nasal cannula, etc.). Decreased tidal volume and/or res. rate will tend to increase the delivered FiO2 whereas increases will cause the opposite (lower fiO2).

All but 2 (simple mask and nonrebreathing mask) are fixed devices, but the venti mask is only able to provide a max fiO2 of 50%. All of the correct selections provide a full range of fiO2 (21-100%) except the nebulizer which starts out at about 28%.