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1 Reference : Egan's Fundamentals of Respiratory Care, 11th Edition Medical Gas Therapy Mohammad Yadak, MHPE,RRT.
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CHAPTER OUTLINE Characteristics of Medical Gases (O2,Air,CO2,He,NO) Gas Cylinders Regulating Gas Pressure and Flow Indications and Hazards of Supplemental Oxygen Oxygen Delivery Systems: Design and Performance Hyperbaric Oxygen Therapy Other Medical Gas Therapies Nitric Oxide Therapy Helium-Oxygen Therapy Carbon Dioxide–Oxygen (Carbogen) Therapy 2.
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Therapeutic Gases Oxygen CO2 He 0 0 0 NO Air 3.
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Oxygen Goals of oxygen therapy •3 goals INDICATIONS \ AARC Clinical Practice Guideline •Documented hypoxemia •Acute care situations in which hypoxemia is suspected •Severe trauma •Acute myocardial infarction •Short-term therapy. Hazards of Oxygen •O2 Toxicity • Absorption atelectasis •Retro- Lental Fibroplasias • Depression of ventilation 4.
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Physiologic Responses to 100% O2 Exposure Time (hr) Physiologic Response 0-12 • Normal pulmonary function • Tracheobronchitis • Substernal chest pain 12-24 • Decreasing vital capacity 25-30 • Decreasing lung compliance • Increasing P(A-a)o2 • Decreasing exercise Po2 30-72 • Decreasing diffusing capacity 5.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Cylinders LOX Concentrators 6.
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Oxygen Over view O2 delivery Monitoring Pressure Hyper-baric Cylinders Pressure Hyper-baric Iso-baric O2 sources LOX Concentrators 7.
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Monitoring Pressure Hyper-baric Iso-baric Oxygen Over view O2 delivery Pressure LOX Concentrators Regulator Flowmeter Blenders Attachments Duration Factor Flow Pressure O2 delivery O2 sources Cylinders 8.
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O2 Cylinders Reducing valve High cylinder pressure Working Pressure Diaphragm, Spring, Pop-off valve Pop-off 9.
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O2 Cylinders Reducing valve Single stage regulator Single reduction chamber One pop-off 2,200 psi 50 psi Multi stages regulator 2 or more chambers pop- off valve for each one 2,200 psi ? psi 50 psi 10.
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O2 Cylinders Flow meters Thorpe tube (Orifice size) Borden gauge (Fixed orifice) 11.
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O2 Cylinders Flow meters Thorpe tube (Orifice size) Borden gauge (Fixed orifice) Comp. Un- Comp. How can we differentiate? Down stream vs. Up stream Humidifiers? Nebulizers ?? Pressure above 50 psi Atm Atm 50 psi 12.
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O2 Cylinders Flow meters Thorpe tube (Orifice size) Borden gauge (Fixed orifice) 13.
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O2 Cylinders Flow meters Thorpe tube (Orifice size) Borden gauge (Fixed orifice) P Flow = P P1 P2 Restriction Back pressure effect 14.
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O2 Cylinders Flow meters Thorpe tube (Orifice size) Borden gauge (Fixed orifice) Which flow meter type is recommended for transportation? 15.
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O2 Cylinders Blenders Air & Oxygen inlet Gas outlet alarm FiO2 adjustment Proportional valve mix O2 & air to give the adjusted FiO2 High flow (100L/min) FiO2 Alarm 16.
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O2 Cylinders Duration Factor= Volume / Pressure 1 cu ft = 28.3 L Duration = Factor × Pressure / Flow E-cylinder = 0.28L/psi H-cylinder = 3.14L/psi 17.
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H-Cylinder Duration= 3.14 ×2200 / 2 Duration=3454 min (57 hrs, 34mins) The cylinder will not last more than 1week !!! COPD patient has H- cylinder at home and he continuously using it on 2L/min nasal canula , he is asking you if it is going to last for 2 weeks ? 18.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Cylinders LOX Concentrators 19.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric Hyper-baric LOX Concentrators Cylinders 20.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric Hyper-baric LOX Concentrators Cylinders More compact Last longer Operate at low P Complications 21.
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LOX Duration 1Ib (liq) = 344L(gas) 1L (liq) = 860L(gas) 1L = 2.5 Ib D = wt (lb) × 860L /2.5 D = wt (lb) × 344L / flow 22.
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100 lb liquid oxygen system Duration= 100 ×344 / 2 Duration=17200 min (286 hrs, 40mins) The liquid system will last around 5 weeks!! COPD patient has 100 lb liquid oxygen at home and he continuously using it on 2L/min nasal canula , he is asking you if it is going to last for 2 weeks ? 23.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Cylinders LOX Concentrators 24.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric Hyper-baric Cylinders Concentrators LOX Flow FiO2 Cost effective Power source Molecular sieve conc. 25.
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O2 concentrator The O2 concentrator machine will last for years Unless unit damage occur!! NOT (8hrs/day) 2L/min 26.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Pressure 27.
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Pressure Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric Hyper-baric 28.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric Hyper-baric LFOS HFOS 29.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric Hyper-baric HFOS LFOS 30.
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Hyper-baric Monitoring O2 sources Face tent Venturi mask O2 delivery Oxygen HFOS Criteria Device Iso-baric Pressure LFOS Aerosol mask Trach collar T-piece 31.
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Over view Pressure O2 sources HFOS Oxygen Magic Box No.1 : No.2 O2 : Air RA 100% FiO2 No.1 O2 No.2 Air ـــ FiO2 0.4 RA = 21% FiO2 0.4 RA = 20% Iso-baric Venturi mask Air - Entrainment FiO2, O2:Air O2 delivery 32.
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Air-Entrainment FiO2 = (Air flow ×0.21) + O2 flow / Total flow O2 flow = Total flow ×(O2% - 21) / 79 Total flow = (O2 + air) × O2 flow 33.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric Hyper-baric LFOS HFOS 34.
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Hyper-baric HFOS Oxygen Pressure Criteria Device LFOS O2 delivery NC Iso-baric HFOS 35.
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Hyper-baric HFOS Oxygen Pressure O2 delivery NC Iso-baric Simple mask HFOS Criteria Devices LFOS HFOS 36.
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Hyper-baric HFOS Oxygen Pressure O2 delivery NC Iso-baric Simple mask PR mask NR mask HFOS Criteria Devices LFOS HFOS 37.
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Oxygen Conserving Devices Reservoir Cannula Pendant Cannula Transtracheal Cath Pulse Dose device 38.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric LFOS HFOS Hyper-baric 39.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric LFOS HFOS Hyper-baric 40.
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Oxygen Pressure Hyper-baric O2 delivery Physiologically Indications Contraindications 41.
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Oxygen Pressure Hyper-baric O2 delivery Physiologically Indications Contraindications Bubble reduction Hyper oxygenation Vasoconstriction Enhanced immune function Neovascularization 42.
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Oxygen Pressure Hyper-baric O2 delivery Physiologically Indications Contraindications 43.
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Oxygen Pressure Hyper-baric O2 delivery Physiologically Indications Contraindications Decompression sickness Air Embolism CO Poisoning Gas Gangrene 44.
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Oxygen Pressure Hyper-baric O2 delivery Physiologically Indications Contraindications 45.
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Oxygen Pressure Hyper-baric O2 delivery Physiologically Indications Contraindications Pneumothorax Sinusitis Obstructive Airways disease Epilepsy, Anxiety 46.
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HBOT Mono-place chamber Multi-place chamber Oxygen vs. air Pt’s No. 47.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources Iso-baric HB 48.
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Oxygen Over view O2 delivery Monitoring Pressure O2 sources O2 analyzer Pulse oximeter Iso-baric HB 49.
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Oxygen Over view O2 delivery Monitoring O2 analyzer Pulse oximeter Pressure O2 sources Iso-baric 50.