Ok so what's going to be a
priority in treatment? This is airway
we know A and B the top of
everything, so what is a top priority?
Correct, the low oxygen - that's our top priority.
So what do we have to do to fix
that low oxygen level or hypoxemia?
We want to minimize the risk of oxygen
toxicity so we don't just crank everybody up.
We try and use the lowest FiO2
that will correct that low oxygen.
Now we usually say say FiO2 because we don't want
to say, fractional oxygen concentration, right?
So it's the fractional oxygen concentration, we
don't want to say all that so we usually just say FiO2.
We want the lowest level that's gonna be effective.
They're usually less than 60% which
is what you will predominantly see
but less than 60% significantly
reduces the risk of oxygen toxicity.
So we're trying to fix that low
oxygen level, what's our next priority?
Well we gotta fix the underlying problem.
While we figure it out, we're going
to be putting oxygen on the patient.
Right now, we're gonna look at okay, what
got them to this point of respiratory failure?
We're gonna look and see,
does the patient need oxygen?
because people who have severe lung diseases
might need long-term or ongoing oxygen support
like therapy or the help of the ventilator.
So I have to figure out what are
we dealing with with each patient.
Now patients with short-term respiratory failure
may only need oxygen while on hospital stay
and they won't even go home on it after discharge.
Chronic people may already be
on oxygen before they come to you
but hopefully acute short-term people are
not gonna have to be discharged on oxygen.
Okay let's talk about the options for oxygen.
This part is kind of fun, this is when you start to feel you're
doing nursing stuff when you're handling the oxygen supply.
So let's talk about the first one - nasal cannula.
Now, you probably know what this is, right?
It has prongs that go into patient's nose,
then the tubing goes around each of their ears
and it joins up underneath their chin.
So that's a patient there's doing fairly okay and
we can put them on oxygen delivered in this manner.
Next up, if a nasal cannula isn't
working, we'll try a mask, right?
After that, we've got non-invasive
positive pressure ventilation.
Now you probably know more
about this than you really think.
So let me introduce you to a
couple of names BiPAP or CPAP.
See, non-invasive positive pressure ventilation
means, I'm not invading the patient's personal body.
Mechanical ventilation requires an intubation.
That's very invasive and they're cramming that
tube in the oral cavity down into their trachea
so we can oxygenate the lungs directly.
Non-invasive is a lot kinder and gentler.
The difference between CPAP and BiPAP is that CPAP is
the equivalent of strapping a hair dryer on your face.
Both BiPAP and CPAP are delivered by masks.
But CPAP is what most people
wear that have obstructive sleep apnea.
So they have that little mask on and they've
got that long tubing that attaches to a small,
humidified air machine at theire bedside table
so CPAP is what most people wear with
sleep apnea and it's one consistent pressure
like an air dryer on your face.
BiPAP has two pressures, that's why it's
called Bi PAP so it's Bi positive airway pressure.
CPAP is constant positive airway pressure.
So with the BiPAP, the pressure
is higher as I'm breathing in
but then it's a lower pressure when I'm
trying to breathe out, so it's not as much work.
Now BiPAP is usually an attempt to keep
somebody off the ventilator, that's our last stop.
Somebody's on nasal cannula,
we're handling things pretty well.
Mask? we needed to bump up game a
little bit due to nasal cannula wasn't working.
and PPV, while they're on BiPAP, we're trying
- to fingers crossed - not intubate that patient
because once they're intubated, they
have to be on mechanical ventilation.
So mechanical ventilation, this
probably's just referred to as ventilator.
I've heard people say, "Oh, we have her on the vent, or
"they're on the ventilator" - that's what they mean.
They've an endotracheal tube in and they are connected
to the mechanical ventilator at special volumes
of air that's delivered and all other kinds of settings
that we can do to help that patient's respiratory system.
Okay, this one is so important, I wanted to unpack
it just a little bit more before we went on.
So the non-invasive positive
pressure ventilation and PPV,
remember we're using air
pressure to keep those airways open
but we don't intubate the
patient, put an endotracheal tube in.
So remember the patient wears a mask, you
see an example of one there in your graphic,
wears a mask or some other device that fits over
just the nose or both on nose and the mouth.
Now there's a tube that's connected to
the mask that then connects to a machine.
Now some people may call that a
ventilator, but it connects to a machine
and that machine is what blows the air
into the tube and therefore into the mask.
Remember CPAP is different than BiPAP,
it's continuous positive airway pressure,
hair dryer on your face, right?
and that is one type of NPPV,
non-invasive positive pressure ventilation.
Just keep repeating that because
after you often hear it referred to
and remember, BiPAP is like even cooler
because it has the two different levels,
a lower pressure when I'm trying
to exhale so it's not as much work.