Seminar on oxygen insufficiency for students of medicine and students of nursing

1. SEMINAR
ON
OXYGEN INSUFFICIENCY

3. • Oxygen is a chemical element with atomic no of 8.
• Oxygen is a gas with no color or smell.
• The term oxygen was first coined by Antoine
Lavoisier.
• Without oxygen, life is not possible on earth.
• The normal amount of oxygen in the external blood
should be in the range of 80-100mmHg.
• If it falls below 60mmHg, irreversible physiologic
effects may occur.

4. Name of gases Formula Volume by %
Nitrogen
Oxygen
Carbon
Dioxide
N2
O2
CO2
78.09 %
20.94%
0.04%
• Air is a mixture of many gases.

5. • Oxygenation is defined as the delivery of oxygen to
all body tissue and cells.
• It depends upon the interplay of :
• Pulmonary System
• Hematologic System
• Cardiovascular System.

6. It includes :-
• Ventilation
• Alveolar gas exchange
• Oxygen transport
• Cellular respiration

7. • Movement of air in and out of the lungs.
•This process is regulated by respiratory centers in the
pons and medulla oblongata.
•Mechanics of ventilation: During inspiration, movement
of the diaphragm and other muscles of respiration
enlarges the thoracic cavity, results in lower the pressure
inside the thorax, as a result air drawn through trachea
and bronchi into the alveoli.
•During expiration, the diaphragm relax and recoil ,the
size of thoracic cavity decrease. The alveolar pressure
exceeds atmospheric pressure and air flow from the lungs
into the atmosphere

8. Airway Resistance: is determined by the size and radius
of airway. Any process that changes the bronchial diameter
or width affects airway resistance and alters the rate of flow
for a given pressure gradient during respiration.
Compliance: It measures the characteristics of the lungs
such as elasticity, expandability, and distensibility.
Compliance allows the lung volume to increase when the
difference in pressure between the thoracic cavity cause air
to flow in. Compliance is normal (1.0L/cm H2O) if the lung
and thorax easily stretch and distend when pressure is
applied.

9. •Once fresh air reaches the lung’s alveoli
• Oxygen moves from area of high concentration
(alveoli) to lower concentration (pulmonary
capillary blood).
• CO2diffuse from blood to alveolar surfaces.

10. •Oxygen is carried in blood either bound to hemoglobin or
dissolved in the plasma.
•Oxygen enters the blood from the respiratory system is
carried to the cells of body by hemoglobin.
•This combination of O2 and hemoglobin is called as
oxyhemoglobin.
•One molecule of Heme contain Four molecules of oxygen.
•It is affected by temperature ,blood pH, partial pressure of
oxygen, partial pressure of CO2

11. Effect of pressure on oxygen transport:.
• O2 and CO2are transported simultaneously either in the blood or
combined with hemoglobin in RBC’s
• Each 100ml of arterial blood contains 0.3ml of O2 dissolved in the
plasma and 20 ml of oxygen in combination with hemoglobin to
form oxyhemoglobin.
• Oxygen dissolved in the plasma is measured by the partial pressure
of oxygen in arteries.
• Amount of oxygen that combine with the hemoglobin depends on
the both the amount of hemoglobin in the blood and on
PaO2(150mmHg).
• This is measured as O2 saturation.

12. •It shows the relationship between the partial pressure of
oxygen(PaO2) and the binding to hemoglobin.
•It indicates the methods used by the body to release
oxygen to the tissues .
•The percentage of saturation can effected by carbon
dioxide, hydrogen ions, temperature.
•An increase in these factors shift the curve to the right, so
that less oxygen is picked up in the lungs, but more
oxygen is released to tissues, if PaO2 is unchanged.

13. •A decrease in these factors causes the curve to shift to the left,
making the bound between oxygen and hemoglobin stronger, so
that less oxygen is given up to the tissues.
•A normal hemoglobin level of 15mg/dl and a PaO2 level of 40
mmHg, adequate level of oxygen is available for the tissues but
no reserve for physiologic stress that increase tissue demand.
•If a serious incident occurs for example, bronchospasm,
aspiration, hypotension that reduces the intake of oxygen from
the lungs, results in tissue hypoxia.

15. •Gas exchange at the cellular level is take place via
diffusion in response to pressure gradient. Oxygen
diffuses from the blood to tissues while carbon
dioxide moves from tissue to the blood, and
transported to the lungs for excretions.

16. Physiological factors
Conditions affecting chest movement
Developmental Factor
Aging
Life Style Risk Factors
Environmental Factors
Medications

17. Decreased oxygen carrying capacity: In case of
anemia decrease the oxygen carrying capacity of
blood by reducing the amount of hemoglobin.
Hypovolemia: Shock results in fluid loss, causes
increase in heart rate and peripheral vasoconstriction,
result in increase in cardiac output.
Decreased inspired oxygen capacity: Due to airway
obstruction, decrease in delivery of oxygen to alveoli.
Increased metabolic rate:Increased metabolic rate
needs more oxygen. when body is unable to meet this
increased demands, the level of oxygen decline.

18. Pregnancy
Obesity
Neuromuscular disease
Musculoskeletal abnormalities
Trauma

19. Prematurity /Surfactant
Young and middle aged adults
Older adults
Infants and toddlers
School aged children

20. Decreased elasticity of thorax and respiratory
muscles
Decrease in total body water, drier mucous
membrane
Loss of elastic recoil during exhalation
Thickening of alveolar membrane, less
efficient for exchange
Less respiratory reserve

21. Smoking: Associated with heart disease,
COPD, and lung cancer
The risk of lung cancer is 10 time greater for a
person who smokes than for a nonsmoker.
Substance abuse: Excessive use of alcohol and
other drug impairs tissue oxygenation
Stress: A continuous state of stress and severe
anxiety increase the metabolic rate and oxygen
demand of the body.

22. •The incidence of pulmonary disease is higher in
smoggy, urban areas.
•A patient’s workplace sometimes increase the
risk for pulmonary disease
•Asbestosis
•Pollutions
•Allergens
•Pollens

24. Oxygen insufficiency is defined as the decrease
in level of oxygen in the body which results in
decrease in perfusion of tissues and other body
cells , which leads to serious health problems.

25. HYPERVENTILATION:A state that required to
eliminate the normal venous carbon dioxide produced by
cellular metabolism.
HYPOVENTILATION: Hypoventilation occurs when
alveolar ventilation is inadequate to meet the body
oxygen demand or to eliminate sufficient carbon dioxide.
In client with COPD, the inappropriate administration
of excessive oxygen can result in hypoventilation.

26. A pathological condition in which the body as a
whole (generalized hypoxia) or a region of the
body (regional hypoxia) is deprived of adequate
oxygen supply.

27. • Peoples are not aware of the
effects of hypoxia. Oxygen
saturation are typically between
90 to 95%.
Asymptomatic
hypoxia
• The body has the ability to stave off
further effects of hypoxia. Oxygen
saturation are between 80 to 90 %
Compensatory
hypoxia
Deterioration or
Disturbance
hypoxia
Critical Hypoxia
The peoples are unable to compensate
with the lack of oxygen .
The terminal stage leading up to death

28. HYPOXIC
HYPOXIA
ANEMIC
HYPOXIA
STAGNANT
HYPOXIA
HISTOTOXI
C HYPOXIA
HYPOXIA

29. Air enter through the respiratory
tract into the lungs
Deliver oxygen to all vital organ
and tissue
If delivery to cell is insufficient
Electron shifted to pyruvic acid

30. Results in anaerobic
metabolism
Inadequate mitochondrial
oxygenation
Leads to death

31. •Shortness of breath,
•Rapid breathing, and
•A fast heart rate
•Cyanosis
•Headache
•Fatigue
•A feeling of euphoria
•The inability to communicate
•Confusion

32. Decrease in partial pressure of oxygen below
65mmHg in the blood. Normal partial pressure
of oxygen in the blood is 80-100mmHg.
CAUSES:
Insufficient ventilation
Respiratory drive
Stroke
Epilepsy

33.  Central sleep apnea
 Hyperventilation
 Suffocation
 Structural deformities of the chest
 Muscle weakness
 Exercise
 Aging

34. •Breathlessness
•Cough
•Hemoptysis
•Cyanosis
•Clubbing
•Sweating
•Wheezing
•Coma

35. Pulmonary Function Tests(PFTs)
•Non- invasive test
•Show how well lungs are working.
•Measures lung volume, ventilator
function, Mechanics of breathing,
diffusion and gas exchange.
•Example: Spirometery

36. INSTRUCTIONS TO PATIENT:
Do not smoke for one hour before the test
Do not drink alcohol within four hour of
test
Do not eat large meal within two hours of
test
Wear loose clothing
Do not perform vigorous exercises within
30 minutes of test

37. •Measure Blood PH and arterial
oxygen and carbon dioxide tension
•PaO2: Arterial oxygen tension
indicate the degree of oxygenation
of the blood
•PaCO2: arterial carbon dioxide
tension indicates the adequacy of
alveolar ventilation.

39. •Allens test is done prior to arterial puncture
•Arterial puncture of medial artery, femoral,
brachial artery
•Heparinised syringe used for withdrawal
•Not more than three pricks should be attempted
•After puncture, apply pressure dressing
•The sample is kept once and transported to
laboratory as soon as possible.

40. •Non- invasive method of monitoring oxygen
saturation of hemoglobin
•A probe or sensor is used to the finger,
forehead, bridges of the nose, earlobe
•Normal value of SpO2 is 95% to 100%.
•Nursing Interventions:
•It should be applied on the nail bed.
•The nails should not have an impaired
circulation
•The sensor should be working i.e a red light
must be seen.
•The probe must be applied to a monitor.

41. •Obtained by expectoration or tracheal, bronchial
suctioning to identify organisms
•Early morning specimen is preferred
• Rinse the mouth with water.
•Take several deep breath, cough deeply to obtain
sputum
•Collect the specimen before starting antibiotic
therapy
•Transport the specimen to laboratory within 2
hours.

43. •Chest X-ray reveal an extensive pathological process
in the lungs in absence of symptoms.
•Densities produced by fluid, tumors, foreign bodies,
and other pathological conditions can be detected.
•X-Ray consists of two views: the posterior-anterior
projection and the lateral projection.

44. •The lungs are scanned in successive
layers by a narrow beam X ray.
• Used to define pulmonary nodules,
small tumor adjacent to pleural surface
that are not visible on routine X ray.
•It may or may not be done with
contrast, when evaluating the
mediastinum and its contents.

45. Similar to CT except that magnetic fields and
radiofrequency signals are used instead of a narrow
beam X- ray. It visualizes soft tissues.
•USES:-
•MRI is used to characterize pulmonary nodules, to
help stage bronchogenic carcinomas and to evaluate
inflammatory activity in interstitial lung disease.
•It is used in acute pulmonary embolism and chronic
thrombolytic pulmonary hypertension.

46. •Assess for any metallic implants
such as pacemaker, pacemaker
wires, or implants. Test will not
be performed if present.
•Explain about procedure.
•Written consent needs to be taken
before procedure

47. •Fluoroscopy is used to assist
with invasive procedure, such as
a chest needle biopsy or
transbronchial biopsy, performed
to identify lesions.
• It also may be used to study the
movement of chest wall,
mediastinum, heart, and
diaphragm.

48. •Pulmonary angiography is used to
investigate thromboembolic disease
of the lungs, such as pulmonary
emboli, and congenital abnormalities
of pulmonary vascular tree.
•It can be performed by injecting the
radiopaque agent into vein with a
needle or catheter.

49. •Informed consent.
•H/O sensitivity to sea foods or iodine needs to be
taken.
•Renal function test is done before contrast
administration.
•Coagulation profile of the patient is checked
before and after the procedure
•Monitor injection site and pulse distal to the site
after the test

50. •It is a radioactive study to evaluate
lung nodules for malignancy
•It give more accurate findings than
CT scan
•PET are used to assess normal
functioning , pulmonary vascular
supply and gas exchange.

51. •Informed consent is required
•No alcohol, coffee, or tobacco, is
allowed for 24 hours prior to the test
•Encourage increased fluid intake post-
test to help eliminate the radioactive
material

52. •Radioisotope lung scan used to
direct inflammatory condition,
adhesion, location and size of
tumors.
•NURSING INTERVENTION
•No special preparation is needed
•Renal function test is done before
the test
•Encourage fluid intake after the test.

53. Direct inspection and examination of the larynx, trachea, and
the bronchi through flexible fiberoptic bronchoscope.
Examine tissue or to
collect secretions
• Determine the location
and extent of pathological
process
• Diagnose bleeding sites.
• Remove secretions.
• To treat postoperative
atelectasis.

54. •Infection
•Aspiration
•Bronchospasm
•Hypoxemia
•Pneumothorax
•Bleeding
•Perforation

55. •Explain the procedure
•Written consent
•Patient kept NPO from 12 hours
•Administer preoperative medicines
•Remove dentures and other prosthesis
•Monitor the patients respiratory status
•Instruct the patient not to take by mouth
•Allow the patient to take liquid
•Report any shortness of breath or bleeding

56. Aspiration of fluid or air from the
pleural cavity .
•PURPOSES:
• Removal of fluid and air from
pleural cavity
•Aspiration of pleural fluid for
analysis
•Pleural biopsy
•Installation of medication
•Studies Gram stain culture and
sensitivity, acid fast staining.

57. •Describe the procedure.
•Vital signs are to be monitored
• Supplementary oxygen
•Observe for signs of distress, such as dyspnea.
•Place the client in sitting position with arms raised and
resting on the table
•If the patient is unable to sit, the patient may be placed in
aside lying position on the edge of the bed on the
unaffected site.

58. •Clean the site with an antiseptic solution
• Local anesthetic at the puncture site
•Don’t remove 1000 ml of fluid from the pleural
cavity within first 30 minutes
•Place a small sterile dressing over the site of
puncture
•The dressing over the puncture site monitored for
bleeding or other drainage
•Monitor patient’s blood pressure, pulse, and
breathing until are stable.

59. NURSING MANAGEMENT OF
PATIENT WITH
OXYGEN INSUFFICIENCY

60. Health history: The health history
focus on the physical and functional
problems and the effect of these
problems on patient. The problems
include Cough, pain, Dyspnea, chest
pain, sputum production.

61. Inspection: Provide information about the
musculoskeletal structure, nutritional status of the
patient, respiratory system.
Palpation: Palpate the thorax for tenderness, mass,
lesions, Respiratory excursion and vocal fremitus.
Percussion: Determine whether underlying tissues
are filled with air, fluid.
Auscultation: Used in assessing the flow of air
through the bronchial tree

62. NURSING CARE PLAN
ON
OXYGEN INSUFFICIENCY

63. DIAGNOSIS:
1. Ineffective airway clearance related to
accumulation of tracheobronchial secretions,
airway spasm, impaired respiratory muscle
function.
GOALS:
• To maintain adequate , patent airway.
• To mobilize secretions.

64. Assess the level of consciousness
Evaluate the rate respiratory rate and breath sounds
Position the patient in upright position
Oxygen therapy is given to patient
Evaluate the amount and type of secretions.
Suction when needed.
Encourage client in deep breathing exercises
Administer medications such as Expectorants,
bronchodilators, and mucolytic agents.

65. 2. Impaired gas exchange related to
decreased ventilation and change in
alveolar capillary membrane.
•GOALS:
•To improve gas exchange
•To improve breathing pattern

66. NURSING INTERVENTIONS
•Assess the respiratory status of the patient
•Oxygen saturation is monitored
•Oxygen is given by low flow oxygen mask to
patients who have chronic pulmonary disease
associated with CO2 retention hypercapnea,
because excessive oxygen may deliberate the
hypoxic derive resulting in apnea
•Head is elevated to promote maximum chest
expansion.

67. 3. Activity intolerance related to
inadequate oxygenation and dyspnea.
•GOALS:
• To improve activity tolerance.

68. •Advice the patient to avoid conditions that
increases oxygen demand such as, smoking,
temperature, excess weight and stress.
•Teach the client to use pursed lip and
diaphragmatic breathing technique during
activities, it leaves positive end expiratory
pressure in the lungs and keep airway open.
•Maintain oxygen therapy as needed.

69. 4. Anxiety related to acute breathing
difficulties and fear of suffocation.
•GOALS:
•To provide comfort, psychologic support.
•To relieve from anxiety
•NURSING INTERVENTION:
•Remain with the client during acute episode
breathing.
•Encourage the use of breathing , retaining and
relaxation technique
•Remain the patient and environment

70. 5.Imbalanced nutrition pattern less the body
requirement related to disease condition.
•GOALS:
•To maintain nutrition pattern
•To maintain intake output balance.
•NURSING INTERVENTIONS
•Instruct the patient for mouth care before meals
•Advised to take high caloric, high protein diet.
•Advised the patient to take soft, easy to eat foods
•Advised to take less amount of milk product.
•High flower position is provided.

71. HUMIDIFICATION
Humidification is the process of adding water to gas.
The percentage of water in the gas in relation to its
capacity for water is the relative humidity. Air or
oxygen with a high relative humidity keeps the airway
moist and helps loosen and mobilize pulmonary
secretions.

72. Nebulization is a process of adding
moisture or medication to inspired
air by mixing particles of varying
size with the air. The moisture added
to the respiratory system through
nebulization improve clearance of
pulmonary secretions. Nebulization
is often used for the administration
of bronchodilators and mucolytic.

73. Therapies used in combination to mobilize
pulmonary secretions. These therapies include
postural drainage, chest percussion, vibration. Chest
physiotherapy should be followed by productive
coughing and suctioning of the client who has
decreased ability to cough. It recommended for
clients who produce greater than 30 ml of sputum
per day.

74. CHEST PERCUSSION:
Striking the chest wall over the
area being drained. The hand is
positioned so that the finger and
thumb touch and the hands are
cupped.
•CONTRAINDICATIONS:
•Bleeding From lung
•Osteoporosis
•Fractured ribs

75. POSTURAL DRAINAGE
Positioning techniques that draw
secretions from specific segments
of the lungs and bronchi into the
trachea. The procedure for postural
drainage can include most lung
segments. Because client may not
require postural drainage of all lung
segments, the procedure is based
on clinical assessment findings. For
example, clients with left lower
lobe atelectasis may require
postural drainage of only the
affected region.

76. The administration of oxygen at a concentration
greater than that found in the environment
atmosphere. Oxygen transport to tissue depends
on factors such as cardiac output, arterial oxygen
content, concentration of hemoglobin, and
metabolic requirement.

77. • A change in the patient’s respiratory status
one of the earliest indicator of the need of
oxygen therapy.
•HYPOXIA: A decrease in the oxygen supply
to the tissues.
•HYPOXEMIA: A decrease in arterial oxygen
in the blood manifested by change in mental
status impaired judgment, agitation,
disorientation, confusion, lethargy and coma,
dyspnea, increase in BP, change in heart rate
•Diaphoresis and cool extremities.

78. There are three types:-
•Compressed oxygen cylinders or
‘green tanks’
•Oxygen concentrators
•Liquid oxygen systems

79. Compressed Oxygen Cylinder
The oxygen gas is compressed in
a gas, which provide a convenient
storage.
•Large oxygen cylinders hold
6,500 litre and can last about
two days at a flow rate of 2 litres
per minute. These tanks can last
4-6 hours when used with a
conserving regulator

80. Chemical reaction based unit can
create sufficient oxygen for a
patient to use immediately,
These units are used for home
oxygen therapy and portable
personal oxygen, they provide
continuous supply without the
need for additional deliveries of
bulky cylinders.

81. Liquid oxygen is stored in chilled tanks until
required, and then allowed to boil to release
oxygen as a gas.

83. Oxygen is administered in low
concentration through a cannula
which is a disposable plastic
device with two protruding
proges (about 1.5cm) for
insertion into the nostrils.
Oxygen is delivered via the
cannulas with a flow rate of up
to 6L/min.

84. •A device used to administer oxygen,
humidity or heated humidity. It is
shaped to fit snugly over the mouth
and nose and is secured in place with
a strap.
•Delivers oxygen concentrations from
30% to 60%.

85. It delivers the highest concentration possible 95 to
100% by mean other than intubation or mechanical
ventilations at liters flow of 10 to 15L/min.

86. The venturi mask uses the
Bernoulli principle of air
entrainment, which provides a high
airflow with controlled oxygen
enrichment. It delivers oxygen at
the rate 4 to5L/min.

87. It is used for clients who cannot tolerate masks.
These provide 30-40% of oxygen concentration at a
flow rate at 4-8 liter/min.

88. •Oxygen is a highly combustible gas. It can easily
cause a fire.
•‘No smoking’ signs should be placed on the client’s
room door and over the bed
•Detect all electrical equipment in the room is
functioning correctly and is properly grounded.
•Locate the closest fire extinguisher.
•Know the fire procedures and the route for evacuation
of the area.

89. Check the name, bed no, and other identification of the
patient.
Confirm diagnosis and need of the patient for oxygen
therapy.
Assess the patient for any clinical anoxia e.g Cyanosis
and also assess the breathing
Monitor for results of ABG
Since oxygen is drug, so it should be monitored for
toxicity

90. Place a calling signal near the patient in case if
nurse is not near to him
For fear of retrolental fibroplasia, give oxygen
to new born babies for a short period at very low
concentration.
Pay attention to kinks in the tubing, loose
connection and faulty humidifying apparatus as it
interferes with the flow of oxygen.
Oxygen supports combustion, fire precaution
are to be taken, when oxygen is on flow.

91. • Passing of tube through the
mouth or nose into the trachea.
•To provide patent airway
•ET tube passed with the aid of
laryngoscope by trained
personels.
•After insertion, a cuff around the
tube is inflated to prevent leakage
•Suctioning of tracheobronchial
secretion is performed through the
tube.

92. An opening is made into the trachea
and indwelling tube is inserted into the
trachea, either temporary or permanent.
PURPOSES:
•To bypass an upper airway
obstruction
•To remove tracheobronchial secretion
•To permit long term use of
mechanical ventilation
•To prevent aspiration of secretion in
the unconscious or paralyzed patient

93. •Bleeding
•Pneumothorax
•Air embolism
•Aspiration
•Dysphagia
•Tracheal ischemia and necrosis

94. • A mechanical ventilator is a positive or negative pressure
breathing device that can maintain ventilation and oxygen
delivery for a prolonged period.

95. •COPD
•Trauma
•Abdominal surgery
•Drug overdose
•Neuromuscular disorders
•Inhalation injury
•Multiple trauma
•Shock
•Multisystem failure
•Respiratory failure

96. Negative pressure ventilation
Positive pressure ventilation

97. Negative pressure ventilators
exert negative pressure on the
external chest, decreasing the
intrathoracic pressure during
inspiration allows air to flow
into the lung, filling its volume.
Uses in chronic respiratory
failure, muscular atrophy. Do
not require intubation of the
airway.

98. Inflate the lungs by exerting positive pressure on the
airway, pushing the air in, Forcing the alveoli to expand
during inspiration. Expiration occurs passively.
Endotracheal ventilation and tracheostomy is necessary.

99. •Pressure- cycled ventilation: it
delivers a flow of air until it reaches a
preset pressure, and then cycle off,
and expiration occurs passively.
•Time-cycled ventilators: terminate or
control inspiration after a preset time.
•Volume-cycled ventilators: The
volume of air delivered with each
inspiration is preset.

100. • Note the change in physical assessment findings.
•Nurse should be expert in pulmonary auscultation
•Monitor for adequate fluid balance by assessing for the presence of
peripheral edema.
•Administration of analgesic to relieve pain.
•Calculate daily intake and output and monitoring daily weight.
•Assess for the presence of secretions by lung auscultation at least
every 2 to 4 hours.
•If excessive secretions are identified , suctioning should be
performed.

101. •Ensure the ET tube or tracheostomy tube is held securely
•Position the ventilator tubing to prevent distoration of
tube
•Maintain hygiene of oral cavity.
•Administer bronchodilators to dilate the constricted
bronchioles
•Humidification of airway via ventilator should be
performed
•Change the position of patient 4 hourly to maintain the
skin integrity.
•Ensure that ventilator tubing is not kinked.
•Maintain aseptic technique to prevent infection.

102. CARDIOPULMONARY
RESUSCITATION

103. Cardiopulmonary resuscitation provide blood
flow to vital organs until effective circulation can
be reestablished after sudden cardiac or
respiratory failure.

104. To provide oxygen to brain, heart, and other vital
organs until appropriate definite medical treatment
can restore normal heart and ventilator function.
•A:-To maintain airway
•B:-To maintain breathing
•C:-To maintain circulation

105. •Respiratory arrest resulting from
drowning, stroke, foreign body,
airway obstructions, smoke
inhalation, drug overdose,
suffocation, myocardial infarction.
•Cardiac arrest

106. •Determine unresponsiveness
•Check the carotid pulse on one side for 5 to 10 seconds
•Initiate CPR within 3-4 minutes
•Call for help
•Position the victims’ chest on flat surface
•Clear the airway for false teeth, food material etc.
•Initiate ventilation and cardiac massage without any delay
•Artificial breathing and cardiac massage
•The ratio of the cardiac compression to ventilation rate is
30:2

107. •Cardiac compressions are given at a rate of 60/min,
where ventilation are given between the cardiac
compression
•The circulation of blood is initiated with the external
cardiac massage
•Discontinue the procedure if the respiration and
circulation are reestablished
•Look for consciousness
•Change in the feeling of pulse
•Blood pressure is normal
•Improved skin color
•Patients vital signs are watched constantly over a
period of 24-48 hours.

108. •Coronary vessel injury
•Diaphragm injury
•Interference with ventilation
•Liver injury
•Myocardial injury
•Pneumothorax
•Rib fracture
•Spleen injury
•Sternal fracture

109. •Maintain airway patency
•Assist with intubation and securing of ET tube
•Insert gastric tube
•Assist with ongoing management of airway
patency and adequate ventilation
•If the CPR is in progress, prepare and
independently double check and label 3 doses of
adrenaline
•Document administered medicines with time.

110. A condition resulting from the harmful
effect of breathing molecular oxygen at
increased partial pressure.
•Oxygen is a drug, it should be
monitor for toxicity.

111. 1.Physiologic Effects of High-Flow Nasal Cannula in
Acute Hypoxemic Respiratory Failure.
• Mauri T1,2, Turrini C1,3, Eronia N4, Grasselli G1, Volta CA3, Bellani
G4,5, Pesenti A1,2.
•ABSTRACT:-
•RATIONALE:
•High-flow nasal cannula (HFNC) improves the clinical outcomes of
nonintubated patients with acute hypoxemic respiratory failure
(AHRF).
•OBJECTIVES:
•To assess the effects of HFNC on gas exchange, inspiratory effort,
minute ventilation, end-expiratory lung volume, dynamic
compliance, and ventilation homogeneity in patients with AHRF.

112. •METHODS:
This was a prospective randomized crossover study
in nonintubated patients with AHRF with
PaO2/setFiO2less than or equal to 300 mm Hg
admitted to the intensive care unit. We randomly
applied HFNC set at 40 L/min compared with a
standard nonocclusive facial mask at the same
clinically set FiO2 (20 min/step).
•CONCLUSIONS:
•In patients with AHRF, HFNC exerts multiple
physiologic effects including less inspiratory
effort and improved lung volume and compliance.
These benefits might underlie the clinical efficacy
of HFNC.