Oxygenation Physiology
What oxygenation process takes place mainly in the lungs? Particularly dealing with the flow of air into and out of alveoli
Ventilation
What is the flow rate range for a nasal cannula?
1-6 Liters (going higher will NOT provide more O2)
What are our two main regulatory systems in the body to maintain acid-base balance?
Respiratory-Lungs: by increasing or decreasing RR rate (CO2 control)
Metabolic-Kidneys: By excreting or hanging onto certain products (Bicarbonate control)
Everyone say our normal lab ranges (for this course) to determine Acid Base imbalance!!
pH :
PaCO2 :
HCO3-:
pH = 7.35-7.45
PaCO2 = 35-45
HCO3-= 21-28
What oxygenation process depends on an adequate blood flow in our bodies?
Perfusion
If your patient states "I am a mouth breather" and their oxygen saturation is at 87%, which device would you opt to use to deliver oxygen?
Simple face mask 5-8L, start low and monitor
or
Oxymask if available (can titrate between 1-15)
An opioid drug overdose would most likely cause which acid-base imbalance?
Respiratory Acidosis due to respiratory depression (decreased RR and trapped CO2)
What is the Acid Base Imbalance? ROME...
pH: 7.55
PaCO2: 20
HCO3-: 26
Respiratory Alkalosis: Respiratory Opposite (ROME)
pH: HIGH
PaCO2: LOW
HCO3-: NORMAL
If your patient has pneumonia...what sound would you expect to hear upon auscultation?
Crackles! Fluid in the lungs
What can happen is we over-oxygenate a patient?
Oxygen Toxicity: excessive/prolonged oxygen exposure can cause cellular damage
List three ways metabolic acidosis could occur.
Hint: how would our acids increase in the body OR how would our bicarb decrease?
Renal failure (failed excretion)
DKA-Keto Acidosis
Lactic Acidosis
Acid ingestion
Diarrhea (remember we lose "bicarb through the bottom")
Ileostomy
What is the acid-base imbalance? ROME...
pH: 7.25
PaCO2: 55
HCO3-: 24
Respiratory Acidosis!
pH: LOW (acidic)
PaCO2: HIGH
HCO3-: NORMAL
What are three findings in EARLY hypoxia?
*Body is trying to compensate for the respiratory problem (neuro status is a big cue)
Confusion, irritability, and restlessness
● Tachypnea (>20)
● Tachycardia
● Pale skin
● Intercostal retractions
● O2<90%
Your patient is no longer maintaining their oxygen saturation above 90% on a simple face mask or Oxymask, what is the next level of device you would consider?
Non-rebreather
Your patient has been vomiting for three days straight...We have identified that they are in metabolic ALKALOSIS
What is the compensating mechanism that you expect to see?
Respiratory! Expect a decreased respiratory rate (in order to hold onto CO2 to balance out the high alkalinity).
-Renal system could also potentially kick in to hold onto bicarb but mainly remember Respiratory!
What is the acid-base imbalance? ROME...
pH: 7.6
PaCO2: 44
HCO3-: 33
Metabolic Alkalosis! Metabolic Equal (ROME)
pH: HIGH
PaCO2: NORMAL
HCO3: HIGH
What are three signs to watch for in LATE hypoxia?
● Stupor (nearly unconscious)
● Cyanosis
● Bradypnea (<12)
● Bradycardia
● Hypotension
● Cardiac dysrhythmias
If you are going to apply a non-rebreather, what do you need to check for?
Inflated bag! Otherwise, it will not work properly
Your patient comes back from surgery. They are in intense pain and is breathing rapidly. 2 Parts:
What Acid Base imbalance could occur if this continues?:
What is one potential intervention?:
Respiratory Alkalosis (breathing off all of our CO2)
-Treat the cause! (Obviously assess where the pain is to determine if any other emergencies present)
^Pain medication to get pain/respirations under control
What is the acid-base imbalance? ROME...
pH: 7.22
PaCO2: 25
HCO3-: 15
*Bonus Pride Points for: Compensation?
Metabolic Acidosis! Metabolic Equal...(from ROME)
pH: LOW
PaCO2: LOW
HCO3-: LOW
Compensation? YES-respiratory system is attempting to compensate